Mar 01 2023
WASHINGTON – U.S. Sen. Mark R. Warner (D-VA) today released the following statement on a new proposed rule by the Drug Enforcement Agency (DEA) governing the use of telemedicine to prescribe controlled substances:
“Given the dramatic shortage of mental health providers nationwide, expanded access to prescribers through telehealth is key to making sure that patients can continue getting their medications, including those that treat opioid use disorder, as they have for the past three years. More than half of U.S. counties don’t have a single psychiatrist. While folks once had to take time off work, commute to a medical facility, and sit in a waiting room, they now can get in front of a prescriber quickly, from nearly any location, and through a single click thanks to pandemic-era telehealth flexibilities.
“Unfortunately, despite what Congress has been directing it to do since 2008, the rule proposed by the DEA once again neglects to set up a special registration allowing specially certified and trained prescribers to continue to safely prescribe controlled substances virtually without requiring an in-person visit. I worry that this rule, as written, overlooks the key benefits and lessons learned during the pandemic, and could counterproductively exacerbate the opioid crisis and encourage more risky behavior by pushing patients to seek dangerous alternatives to proper health care, such as self-medicating, if they cannot access an in-person appointment with a specialized provider.”
During COVID-19, patients widely adopted telepsychiatry as a convenient and accessible way to get psychiatric care remotely. This was made possible by the COVID-19 Public Health Emergency, which allowed for a number of flexibilities, including utilizing an exception to the in-person medical evaluation requirement under the Ryan Haight Online Pharmacy Consumer Protection Act, legislation regulating the online prescription of controlled substances. With the Public Health Emergency set to expire, patients will soon lose the ability to reap the benefits of a mature telehealth system whose responsible providers know how to take care of their patients remotely when appropriate.
Since 2008, Congress has directed the DEA to set up a special registration process, another exception process under the Ryan Haight Act, that would open up the door for quality health care providers to evaluate a patient and prescribe these medications over telehealth safely, as they’ve done during the pandemic. This special registration process has yet to be established, and DEA wrote they believe this proposed rule fulfills those Congressional mandates, despite not proposing such a registration.
Sen. Warner, a former tech entrepreneur, has been a longtime advocate for increased access to telehealth. He is an original cosponsor of the CONNECT for Health Act, which would expand coverage of telehealth services through Medicare, make COVID-19 telehealth flexibilities permanent, improve health outcomes, and make it easier for patients to safely connect with their doctors. He previously wrote to both the Biden and Trump administrations, urging the DEA to finalize regulations long-delayed by prior administrations allowing doctors to prescribe controlled substances through telehealth. Sen. Warner also sent a letter to Senate leadership during the height of the COVID-19 crisis, calling for the permanent expansion of access to telehealth services.
In 2018, Sen. Warner included a provision to expand financial coverage for virtual substance use treatment in the Opioid Crisis Response Act of 2018. In 2003, then-Gov. Warner expanded Medicaid coverage for telemedicine statewide, including evaluation and management visits, a range of individual psychotherapies, the full range of consultations, and some clinical services, including in cardiology and obstetrics. Coverage was also expanded to include non-physician providers. Among other benefits, the telehealth expansion allowed individuals in medically underserved and remote areas of Virginia to access quality specialty care that isn’t always available at home.