DEA, HHS Extend Telemedicine Flexibilities Through 2024

The Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) last week announced the extension of COVID-19 telemedicine flexibilities for prescription of controlled medications through December 31, 2024. These telemedicine flexibilities authorize qualified health professionals to prescribe to patients Schedule II-V controlled medications via audio-video telemedicine encounters, including III-V narcotic-controlled medications approved by the Food and Drug Administration for the treatment of opioid use disorder via audio-only telemedicine encounters.

The extension is the latest in a series of efforts that began in February aimed at the creation of a final set of regulations for prescribing controlled substances via telemedicine appointments.

Ahead of the expiration of the COVID-19 Public Health Emergency earlier this year, the DEA proposed two new regulations: “Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation” and “Expansion of Induction of Buprenorphine Via Telemedicine Encounter.”

While the proposed rules did not fully reverse course on the telemedicine flexibilities allowed during the Public Health Emergency (PHE), many saw the regulations as a step in the wrong direction by re-instituting in-person care requirements for the prescription of controlled substances.

APA filed two letters in response to these proposed rules in March, urging that the DEA balance common-sense safeguards for DEA enforcement without decreasing access to lifesaving treatment.

APA’s comments were among the more than 38,000 that the agency received on the proposed telemedicine rules during the 30-day public comment period. The day before the public health emergency was set to expire, the DEA and Substance Abuse and Mental Health Services Administration issued a temporary rule extending the full set of telemedicine flexibilities adopted during the Public Health Emergency for six months.

In September, the DEA held two days of public listening sessions related to the rules. Psychiatrist Shabana Khan, M.D., chair of the APA Committee on Telepsychiatry, spoke on behalf of APA at the meeting.

“Rather than a mandatory blanket requirement [for an in-person visit], the need for an in-person examination of a patient really should be left to the clinical discretion of a practitioner who has the knowledge, skills, and experience to make that decision,” Khan said. “Reducing flexibility in modalities of care increases inequity, forcing practitioners to cherry-pick patients that have the ability to travel to in-person care.”

Khan, who is the director of child and adolescent telepsychiatry at NYU Langone Health and an assistant professor of child and adolescent psychiatry at NYU Grossman School of Medicine, noted that the existing standards and regulations around prescribing controlled substances provide a high level of oversight and accountability of prescribing practices.

“There is no evidence that telemedicine prescribing during the COVID-19 PHE increased diversion or negative outcomes associated with access to controlled substances,” APA President Petros Levounis, M.D., M.A., told Psychiatric News. “In fact, initial data indicate that telehealth initiation in the care of patients with opioid use disorder increased retention in treatment.”

The DEA hopes to have a final set of telemedicine regulations by the fall of 2024. “The purpose of this second temporary rule, like the one before it, is to ensure a smooth transition for patients and practitioners that have come to rely on the availability of telemedicine for controlled medication prescriptions, as well as allowing adequate time for providers to come into compliance with any new standards or safeguards,” said DEA and HHS in the temporary extension.

Since 2017, the U.S. opioid crisis has been categorized as a public health emergency, APA CEO and Medical Director Saul Levin, M.D., M.P.A., noted. According to the Centers for Disease Control and Prevention, overdoses involving opioids killed more than 80,000 people in 2021.

“APA appreciates DEA’s efforts to learn from the lessons of the COVID-19 PHE in maintaining access to critical, life-saving care through technology,” Levin told Psychiatric News. “The DEA has the opportunity to get the balance right by finalizing rules that facilitate, rather than prevent, access to high-quality care.” ■