Mental health advocates seek changes to proposed telehealth rule on prescribing controlled medications

A broad coalition of health care providers and behavioral health advocates is calling on the Drug Enforcement Administration (DEA) to modify a proposed rule curtailing doctors’ ability to prescribe some controlled medications based solely on virtual visits.

In a March 28 letter to DEA Administrator Anne Milgram, the 74 signatory organizations say they are “anxious to ensure continued access to care for patients with telehealth-based provider relationships that include a controlled substance,” but that the proposed rule will “substantially curtail” such access. The American Telemedicine Association has expressed similar concerns.

The proposed rule, announced February 24, would make permanent many of the telemedicine flexibilities introduced at the start of the COVID-19 public health emergency with what the DEA calls “appropriate safeguards.”

These would apply to consultations where the practitioner has never evaluated the patient in person and that result in prescribing of a controlled medication. Under those circumstances, practitioners could prescribe no more than a 30-day supply of Schedule III-V non-narcotic controlled medications, or a 30-day supply of buprenorphine for treating opioid use disorder, without evaluating the patient in-person or a referral from a practitioner that has performed such an evaluation.

The proposed rule includes a 180-day grace period for patient-provider relationships established during the public health emergency.

In a summary of the proposed rule the Alliance for Connected Care, one of the signatories to the letter, said the rule’s effect would be to “effectively end most patient-provider relationships established over the last three years which rely on a telehealth practitioner prescribing a controlled substance.”

The letter to the DEA notes that 40% of American adults report symptoms of anxiety and depression, and that connecting more Americans to mental health care is part of President Biden’s strategy for improving the nation’s mental health. “Unfortunately, the broader behavioral health workforce is stretched…meaning that the goals of this plan are unlikely to be met without access to empowered virtual care,” it says.

The letter concludes with a request that the DEA modify the proposed rule “to ensure more flexible prescribing limitations for providers when a controlled substance is offered by a highly-trained clinician in conjunction with an ongoing mental health treatment plan.”