AAFP, Other Groups Decry DEA Telemedicine Rule-making Delay

That’s the gist of a letter that more than 80 health care professional, insurer, behavioral health and telehealth provider groups ― including the AAFP ― recently sent to the Drug Enforcement Administration, calling for the agency to “expedite and complete its efforts to implement a telemedicine special registration process enabling providers to safely prescribe controlled substances remotely.”

In the Oct. 26 missive to DEA Acting Administrator Timothy Shea, the organizations urge that the special registration process outlined in a provision of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act of 2018 be finalized so physicians and other qualified health care professionals can use telemedicine to prescribe certain medications to treat substance use disorders.

According to the letter, the SUPPORT Act provision stipulates that “no later than one year after enactment,” the Department of Justice, in concert with HHS, shall “promulgate final regulations specifying the circumstances in which a special registration for telemedicine may be issued and the procedure for obtaining the registration.”

“It has now been two full years since the SUPPORT Act was signed into law with no appreciable progress in moving forward a rulemaking process to implement this key telemedicine provision,” the groups point out.

The need is critical. Although 2018 brought some indications that the epidemic might be slowing, with opioid prescribing dropping as the use of state prescription drug monitoring programs rose, research that came out the following year suggested that opioid-related mortality would continue to rise in the coming years even with reduced prescribing as misuse of illicit opioids increased.

And now, says the letter, the pandemic has only exacerbated the problem. “In the six months since COVID-19 brought the nation to a standstill, the opioid epidemic has taken a sharp turn for the worse,” say the groups. “More than 40 states have recorded increases in opioid-related deaths since the pandemic began.”

National statistics are similarly alarming,  with overdose case numbers leapfrogging from month to month compared with 2019, they add. “Given the opioid use crisis now heavily impacting the United States, the DEA’s delay is difficult to comprehend.”

The letter acknowledges temporary actions HHS has taken since the coronavirus epidemic was declared a public health emergency in January, including employing its authority to waive an array of restrictions and limits on telemedicine. It also commends the DEA for acting in concert with the Substance Abuse and Mental Health Services Administration to exercise its regulatory authority “to permit remote prescribing of controlled substances using telemedicine without a prior in-person exam, regardless of the patient’s location,” in some circumstances. But such short-term measures aren’t sufficient, say the groups.

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

To further drive home their point, the groups cite a Health Affairs Blog post written by medical experts on the issue that affirmed telehealth’s efficacy in managing patients who had started buprenorphine treatment after an in-person visit, and they point to the Department of Veterans Affairs’ success in implementing buprenorphine management of opioid use disorder via telehealth.

Finally, the letter points out that the rule-making the groups are seeking would align closely with an Oct. 5 executive order that especially benefited patients with OUD who live in rural or urban underserved areas.