DEA Pressured to Create a Telehealth Registration for Drug Abuse Treatment

October 26, 2020 - Telehealth advocates are once again putting pressure on the US Drug Enforcement Agency to finalize a special registration process so that care providers can use telemedicine to prescribe certain medications for substance abuse treatment.

More than 80 organizations, ranging from telehealth health providers and health systems to the American Telemedicine Association and America’s Health Insurance Plans, have signed a letter asking Acting DEA Administrator Timothy Shea to create the registration process mandated in the Ryan Haight Act of 2008 and the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018.

“Our experience during COVID-19 has demonstrated the value of increased access to telemedicine to enable all qualified providers, including Community Mental Health Centers and addiction treatment facilities, to prescribe Medication-Assisted Treatment (MAT) to patients with Opioid Use Disorder (OUD),” the letter, penned by the Alliance for Connected Care, states.

The Ryan Haight Act laid the groundwork – reinforced by the SUPPORT Act – for a special registration that would allow providers to prescribe, deliver, distribute and dispense a controlled substance to patients without the requirement for an in-person examination. The idea behind the registration is to allow providers to use connected health platforms – including MAT therapy therapy - to treat patients living with substance abuse issue who might not have easy access to in-person treatment.

The registration would come with certain conditions:

• Providers must demonstrate a legitimate need for the special registration;
• They must be registered to deliver, distribute, dispense or prescribe controlled substances in the state where the patient is located; and
• They must maintain compliance with federal and state laws when delivering, distributing, dispensing and prescribing a controlled substance.

Telehealth advocates and even lawmakers have been putting pressure on the government to create that registration process long before the coronavirus pandemic, to no avail.

Several organizations, including the ATA, Center for Telehealth & eHealth Law (CTeL) and, more recently, the Buprenorphine Telehealth Consortium have lobbied for the registration, and a handful of bills have been drafted calling for that process as well. Earlier this year, Senator Mark Warner (D-VA) specifically called on the DEA to make the registration a reality.

“Providers across the country have been frustrated in their inability to provide adequate care as they wait for Congressionally-mandated guidance from your agency to clarify the process whereby health care professionals can legally use telehealth to better treat patients suffering from substance use disorder,” Warner wrote in January. “The DEA’s failure to promulgate the rule has meant that – despite Congress’ best efforts – many patients suffering from substance use disorders remain unable to access treatment via telehealth. These patients cannot afford to wait and we are concerned the DEA is standing in the way of treatment for individuals that cannot access a provider in person – particularly those in rural and underserved areas.”

Those signing the latest letter point to a surge in substance abuse issues brought on by COVID-19, including increases in drug overdoses in more than 40 states and nationwide increases of 18 percent in March, 29 percent in April and 42 percent in May.

“Since the onset of the coronavirus epidemic Public Health Emergency (PHE), HHS has employed its authority under Section 1135 of the Social Security Act to waive a wide array of restrictions and limits on telemedicine imposed under Section 1834(m) of the Act,” the letter points out. “The DEA also recognized the immediate need for expanded access to remote care during the pandemic and, in partnership with the Substance Abuse and Mental Health Services Administration (SAMHSA), exercised its regulatory authority to permit remote prescribing of controlled substances using telemedicine without a prior in-person exam, regardless of the patient’s location (if the prescribing is medically appropriate and the prescriber is DEA-registered). In particular, this has allowed buprenorphine/Suboxone initiation over telemedicine.”

“While we appreciate these PHE-related changes, statute requires the implementation of a permanent regulation,” the letter adds. “The time for that regulation is long overdue.”