Just one day before the COVID-19 Public Health Emergency was set to expire, the United States Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued the “Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” to temporarily extend telemedicine flexibilities.
This announcement follows the March 1, 2023, notices of proposed rulemakings published by the DEA and Department of Health and Human Services (HHS), that would allow for the prescribing of certain controlled medications through telemedicine without requiring an in-person medical evaluation of the patient (under certain conditions that are consistent with public health, safety, and effective controls against diversion).
SAMHSA and DEA both “strongly support policies that promote access to effective and safe treatment for opioid use disorder,” including through the use of telemedicine, and ensuring that patients have continued access to their necessary prescribed medications past the COVID public health emergency.
The temporary rule took effect on May 11, 2023, and will extend the full set of telemedicine flexibilities adopted during the COVID-19 public health emergency through November 11, 2023. Additionally, for practitioner-patient relationships that are (or will be) established prior to November 11, 2023, the full set of telemedicine flexibilities regarding prescribing controlled medications will be extended for an additional year, through November 11, 2024.
According to DEA Administrator Milgram, the DEA “received a record 38,000 comments on its proposed telemedicine rules” and understands “the importance of telemedicine in providing Americans with access to needed medications.” As a result, the agency is opting to extend the flexibilities “for six months while we work to find a way forward to give Americans that access with appropriate safeguards.”
Miriam E. Delphin-Rittmon, the HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA, notes that “access to evidence-based treatment is a pillar of the HHS Overdose Prevention Strategy” and that “policies that promote access to effective and safe treatment for opioid use disorder, including through telemedicine platforms, and ensuring continued access to necessary controlled mediations past the COVID-PHE” are important.
The DEA will continue to evaluate the more than 38,000 comments received on the notices of proposed rulemaking and aims to produce a final rule that allows the practice of telemedicine under circumstances that are consistent with public health, safety, and effective controls against diversion. The temporary rule will allow for a smooth transition for patients and providers alike, as well as allow additional time for providers to become compliant with any new standards or safeguards published in future final rules.
This reversal highlights the importance of telemedicine in today’s healthcare arena. Between this extension and the DEA’s seeming commitment to considering the 38,000 comments submitted in response to the proposed rule, it will not be easy to put the “cat back in the bag,” so to speak. Telemedicine is proving that it is more than just a pandemic fad, but serves as an important tool for patients, particularly those in rural and underserved areas.
The American Telemedicine Association and ATA Action issued a statement commending the temporary rule, saying, “It is especially important and encouraging that these actions cover access to clinically appropriate prescriptions of controlled substances that patients need for a wide variety of medical circumstances, including for mental health and substance use disorders.”