DEA Allowing Telehealth for Opioid Prescriptions
/By Pat Anson, PNN Editor
Pain patients who are self-isolating during the coronavirus outbreak may be able to get an opioid prescription without visiting their doctor.
In an update on its COVID-19 Information Page, the U.S. Drug Enforcement Administration said prescribers and patients can connect remotely via telehealth – also known as telemedicine -- to get a prescription for opioids and other controlled substances.
The exemption from the Controlled Substances Act was made possible by the public health emergency declared on January 31 by Health and Human Services Secretary Alex Azar. On March 16, Azar and Acting DEA Administrator Uttam Dhillon agreed to allow telemedicine to be used for the prescribing of Schedule II through Schedule V opioids and other controlled substances.
“While a prescription for a controlled substance issued by means of the Internet (including telemedicine) must generally be predicated on an in-person medical evaluation, the Controlled Substances Act contains certain exceptions to this requirement,” the DEA said.
“For as long as the Secretary’s designation of a public health emergency remains in effect, DEA-registered practitioners may issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation.”
The exemption applies to both new prescriptions and renewals, provided the following conditions are met:
The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of their professional practice.
The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system
The practitioner is acting in accordance with federal and state laws.
Doctors were already allowed under federal law to use telehealth to prescribe controlled substances, but only if they had previously conducted an in-person medical evaluation of the patient. The exemption essentially waves that first face-to-face meeting.
“During this uncertain time, DEA remains flexible and committed to ensuring that the nation’s drug supply chain is uninterrupted,” Dhillon said in a statement. “DEA continues to work with our public health partners to explore options that ensure those in need of vital prescriptions are able to get them, while still adhering to safe practices such as social distancing.”
‘Unaware of Any Shortages’
The DEA also said it was working with the FDA to monitor the supply of medications and was “unaware of any shortages of controlled substances at this time.”
That is a misleading statement, because there are 145 drugs currently listed in an FDA database of drug shortages, including several opioids that are primarily used for anesthesia during medical procedures. The drugs were in short supply even before the coronavirus outbreak.
Last month, the FDA said it was notified by a drug manufacturer that it was experiencing a shortage of one medication due to the coronavirus outbreak. The drug was not identified.
Many ingredients and raw materials used in drug manufacturing are imported from China and India. According to a recent study, nearly two-thirds of the world’s supply of acetaminophen comes from China.
Emergency Refills
Some states are also taking steps to ensure that patients are not deprived of medications during the coronavirus outbreak.
Florida Surgeon General Scott Rivkees issued an emergency order authorizing the use of telemedicine for prescribing opioids and other controlled substances “only for an existing patient for the purpose of treating chronic nonmalignant pain without the need to conduct a physical examination.”
This Washington State Medical Commission authorized pharmacists to grant emergency 72-hour refills for prescriptions that are not maintenance medications. A 30-day emergency supply of maintenance medications was authorized if a pharmacist is unable to obtain refill authorization from the prescriber.
Maintenance medications are drugs used to treat conditions that are chronic or long-term, such as high blood pressure, heart disease, diabetes and, presumably, chronic pain.
The Washington State Department of Health also asked insurance companies to allow patients to get a one-time refill of their prescriptions before the end of the waiting period between refills.
