- President Donald Trump’s surprise announcement this week to declare a national emergency on opioid abuse could thrust telemedicine and mHealth into the spotlight.
If and when it happens, the declaration would “enable the federal government to quickly free up funds and allow greater regulatory flexibility to respond to the epidemic,” according to Politico. That might include giving healthcare providers more freedom to use telemedicine and telehealth platforms to treat people with addiction problems.
"[T]he DEA has been extremely slow in correcting it to allow telemedicine to be used to treat addicts," Peter Yellowlees, president of the American Telemedicine Association and a psychiatrist at UC Davis, told the online news site. "There are quite a few addiction specialists and psychiatrists who would be happy to work via telemedicine and who currently cannot do so because of the [regulatory] restrictions."
"Telemedicine prescribing of anti-addiction medicines is especially important as a means of responding to the opioid epidemic as there are more patients in need of treatment than there are providers available in-person to treat,” added Libby Baney, of Faegre Baker Daniels Consulting.” Telemedicine could make a big difference in getting patients access to treatment faster, saving lives.”
Providers have long been hampered in treating addictions via telemedicine because of the Ryan Haight Act. The landmark 2008 law prohibits physicians from prescribing controlled substances electronically until they have conducted an in-person examination, or if they meet the federal definition of practicing telemedicine, which requires that the patient be treated by, and physically located in, a hospital or clinic which has a valid DEA registration; and the telemedicine practitioner is treating the patient in the usual course of professional practice.
Lisa Schmitz Mazur, an attorney with McDermott Will & Emery who specializes in telemedicine, telehealth and mHealth, says the U.S. Drug Enforcement Agency, which oversees Ryan Haight, has been hinting at issuing an amendment before the end of this year that would allow providers to prescribe controlled substances via telemedicine if they first register with the U.S. Attorney General.
That decision could be made for them if a public health emergency is declared. According to the Health and Human Services website, such a declaration would “modify” the Ryan Haight Act.
Mazur says some states have enacted legislation that allows providers to prescribe some controlled substances via telemedicine, but federal law overrules state legislation.
“It’s creating an environment where healthcare providers are not wanting to do this at all,” she says. “It has become too complicated.”
Mazur says federal officials should be giving doctors more authority to use telemedicine to prescribe controlled substances, particularly as healthcare moves toward accountable care and coordinated models of care.
“Telehealth has changed so much since 2008,” she points out.
According to NPR, while Trump stated that he was declaring an emergency, he and his administration haven’t formally declared one – “a process that comes with specific legal authority and brings specific sets of powers and access to money.”
Should that happen, the president would be able to:
- Use authority under the Stafford Act to declare an emergency, opening up resources like FEMA's disaster relief fund, which had about $1.5 billion available as of July.
- Ask Health and Human Services Secretary Tom Price to declare an emergency under the Public Health Service Act, which would free up researchers and public health workers to work on the crisis.
- Give Price the authority to enable providers to administer certain controlled drugs, like naloxone, methadone or buprenorphine, to patients with opioid addictions without restrictions.
- Waive Medicaid restrictions to pay for more treatments.
- Pressure Congress to devote more funding to the opioid crisis.
- Enable states (six have, to date, declared opioid emergencies) to receive more funding.
Telemedicine isn’t exactly a new weapon in the battle against opioid abuse.
Last July, the Agency for Healthcare Research and Quality (AHRQ) launched a three-year, $9 million effort to train rural healthcare providers in medication-assistant treatment (MAT) therapy. The project uses mHealth apps, online training and specialist consults to help primary care physicians treat an estimated 20,000 residents fighting opioid addiction.
The AHRQ effort targets Oklahoma, Colorado and Pennsylvania, where officials say the opioid abuse epidemic is particularly hard-hitting. In Muskogee County, Okla., for instance, more than 10 opioid-related deaths for 10,000 people have been reported over the last few years, while more than 1,300 are thought to be in need of treatment in a county that has no MAT-certified physicians. And in Bent, Colo., the number of overdose deaths has doubled from 10 to 20 per 100,000 since 2002.
The project’s launch came on the heels of the latest round of U.S. Agriculture Department Distance Learning and Telemedicine (DLT) grants, several of which were earmarked for healthcare providers tackling the opioid epidemic.
"Using technology for educational opportunities and medical care can provide services that are often unavailable in rural areas," U.S. Agriculture Secretary Tom Vilsack said in announcing $23.4 million in federal grants in July 2016. “For example, opioid and other substance misuse disproportionately affect rural areas, and telemedicine is proving to be an effective tool for treating patients when experts otherwise would be unavailable. Hospitals, schools and training centers across the country are successfully using telecommunications to deliver specialized care to area residents."