Feb. 26, 2023 – Although the Drug Enforcement Agency wants to continue many of the pandemic-era flexibilities for prescribing controlled substances via telemedicine, it plans to make changes on the prescribing criteria for ADHD medications and highly addictive drugs like opioids, the agency announced Friday.
If approved, the changes will take effect when the public health emergency ends on May 11.
“DEA is committed to ensuring that all Americans can access needed medications,” said DEA Administrator Anne Milgram in a statement. “The permanent expansion of telemedicine flexibilities would continue greater access to care for patients across the country, while ensuring the safety of patients. DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm.”
The proposed rules are designed to help medical providers ensure what is known as “continuity of care,” meaning that patients can continue to get most treatments while being given the time to arrange in-person visits.
If someone has seen their provider in person, they can later be prescribed any controlled substance via a telemedicine visit. Additionally, if someone has seen a provider in-person, and that initial provider sends a referral to another provider, such as a specialist, then the specialist can prescribe a controlled substance via telemedicine.
The proposed limitations, which apply to schedule II through V substances, are as follows:
- Schedule II substances -- such as opioids, Adderall, and Vicodin -- require an in-person visit.
- Schedule III through V substances can be prescribed for 30 days after an initial telemedicine visit, but then an in-person visit is required for a refill.
- Buprenorphine for treatment of substance abuse can be prescribed for 30 days after an initial telemedicine visit, but then an in-person visit is required for a refill.
Schedule III through V drugs include anabolic steroids, Ambien, Tramadol, Valium, Xanax, Lomotil, and Lyrica.
The proposal does not impact getting a prescription via telemedicine for non-controlled substances, such as birth control, blood pressure or cholesterol medicines, antibiotics, skin creams, or insulin.
In a press release, the DEA suggested people look up their medication on this list to see whether or not it is a controlled substance.
The prescribing flexibilities for controlled substances that were allowed during the pandemic were credited with improving access to treatments, particularly for people in rural areas. The flexibilities were also seen as addressing the shortage of qualified prescribers, such as psychiatric medical providers who often book appointments weeks in advance.
However, critics say the relaxed system has resulted in people being prescribed medications that they don’t need. Rising addiction rates also have increased calls for a return to in-person appointments.
“Both sides of this tension have really good points. You don’t want barriers in the way of getting people prescriptions they need. But anytime you remove those barriers it’s also an opportunity for profit seekers to exploit the lax rules and sell the medicines to people who may not need them,” University of Buffalo associate professor David Herzberg, PhD, an expert on the opioid epidemic and the history of prescription drugs, told The Associated Press.
The DEA is currently gathering public comment on the proposed changes for 30 days.