Written by Christopher A. Parrella, J.D., CPC, CHC, CPCO
The clock is ticking for the Drug Enforcement Administration (DEA) to address a long-standing roadblock that has prohibited physicians and nurse practitioners from prescribing controlled substances via telemedicine without an in-person exam.
In late October, President Trump addressed the opioid crisis by signing into law SUPPORT for Patients and Communities Act. Within that legislation is the Special Registration for Telemedicine Clarification Act of 2018. It requires the DEA to activate a special registration allowing practitioners to prescribe controlled substances via telemedicine. It gave the DEA one year to do so.
Providers have been limited in their ability to prescribe controlled substances via telemedicine by the Ryan Haight Online Pharmacy Protection Act of 2008. The law was passed by Congress in response to the death of a teenager who bought prescription painkillers from an online pharmacy without seeing a physician in person. Designed to prevent rogue internet pharmacies from selling controlled substances online, the law created widespread barriers by preventing providers from prescribing a controlled substance via telemedicine, unless there had been an in-person exam.
The Ryan Haight Act included a statutory mandate requiring the DEA, or other federal agency, to promulgate final regulations that specify the limited circumstances in which a special registration may be issued and the procedure for obtaining a special registration. However, that never happened.
There were some exceptions, but they were narrow and did not align with how telemedicine is practiced today. As a result, it has limited treatment options, particularly for those living in underserved communities.
The DEA recently released a report that found prescription drugs, including opioids, were responsible for the most overdose deaths and were the second most commonly abused substance in the United States. The report found an average of 174 people died each day in 2016 from drug poisoning and drug-related deaths.
It remains unclear at this point how the DEA plans to address this edict. The question that needs answering is under what “limited circumstances” will providers receive this special legislation? The law does allow a 60- or 90-day period for the public to submit comments, consider and respond to those comments, and then publish the final regulations.
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