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DEA to Launch Registration Process for Prescriptions by Telemedicine

Federal officials are finally moving forward with a registration process for healthcare providers who want to prescribe controlled substances through telemedicine, as outlined in the Ryan Haight Act.

Source: ThinkStock

By Eric Wicklund

- Healthcare providers may soon be able to register with the federal government to use telemedicine to prescribe controlled substances.

The Justice Department has issued a long-awaited – and overdue – proposed rule to create a special registration process for providers looking to expand their telehealth platform to, among other things, improve treatment for people struggling with substance abuse issues.

The “Special Registration to Engage in the Practice of Telemedicine” was called for in the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which strongly regulated a provider’s ability to prescribe controlled substances. Under the Ryan Haight Act, providers are required to conduct an in-person examination before prescribing or otherwise dispensing controlled substances “by means of the Internet,” except when engaged in the practice of telemedicine. The definition of “practice of telemedicine,” meanwhile, includes seven categories in which a provider could meet the in-person requirement through a virtual care platform – including under a special registration granted by the US Drug Enforcement Agency. But that registration process was never created by the DEA.

With the Special Registration for Telemedicine Act of 2018, which was part of the SUPPORT for Patients and Communities Act signed into law by President Donald Trump in late 2018, the DEA had until October 24 to set the ground rules for providers with a special registration to prescribe controlled substances. That action didn't take place until this week.

Organizations like the Center for Telehealth & e-Health Law and the American Telemedicine Association have been lobbying the DEA to take that step.

“Telemedicine has exceptional potential to provide high-quality, accessible healthcare amidst an ongoing opioid epidemic, but telemedicine practitioners are needlessly hindered by current regulations,” Curtis Lowery, MD, CTeL’s chairman, said in a September letter to the DEA. “When developing the special registration for telemedicine providers, we ask that the Attorney General and the DEA keep in mind the needs of many patients for whom controlled substances can play a vital therapeutic role. Enhancing those patients’ access to mental health and substance abuse practitioners will have only a positive effect on their ability to resolve their disorders effectively.”

“The telemedicine community has long advocated for activation of special registration to relieve the regulatory impasse that confronts many telehealth prescribers,” ATA CEO Ann Mond Johnson wrote in a separate letter this past Janua. “Activation of the special registration provision will not only allow additional prescribers to use telemedicine to combat the opioid crisis, but also provide the broad range of medical disciplines an avenue to expand access to quality care.”

The ruling was tweeted out on Wednesday and hailed by Nathaniel Lacktman, an attorney with the national law firm of Foley & Lardner and chair of its Telemedicine and Digital Health Industry Team. Lacktman had also long called for this move.

“The practice of telemedicine has evolved exponentially in the decade since the Ryan Haight Act was passed, and the regulations fail to account for how legitimate telemedicine services are delivered today,” he wrote in a March 2018 blog with Thomas B. Ferrante, a senior counsel with the firm. “For that reason, the exceptions do not easily align with direct-to-patient service models frequently sought by patients in areas such as telepsychiatry or substance use disorder treatment. In addition, there is a nationwide shortage of psychiatrists and board certified substance abuse addiction specialists, coupled with the nation’s tragic opioid crisis, making telemedicine services an attractive resource.”

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