WASHINGTON (AP) — The Biden administration moved Friday to require patients to see a doctor before taking attention deficit disorder medication or other addictive drugs, increasing access to the drug against a backdrop of a deepening opioid crisis.
The proposal could overhaul the way millions of Americans get prescriptions after three years of relying on telehealth for doctor appointments by computer or phone during the pandemic.
The Drug Enforcement Administration said Friday it plans to finally reinstate long-standing federal requirements for powerful drugs that were scrapped in the wake of COVID-19, allowing doctors to write millions of prescriptions for drugs such as OxyContin or Adderall without ever seeing a patient.
Patients must see a doctor in person at least once to get an initial prescription for drugs that the federal government says have the most potential for abuse – Vicodin, OxyContin, Adderall and Ritalin, for example. Refills can be given via telehealth appointment.
The agency will also enforce how doctors can prescribe other, less addictive drugs to patients they have never met. Substances like codeine, taken to relieve pain or cough, Xanax, used to treat anxiety, Ambien, a sleep aid, and buprenorphine, a narcotic used to treat opioid addiction, can be prescribed via telehealth for an initial 30-day dose. Patients should see their doctor at least once to get refills.
Patients can still get common prescriptions like antibiotics, skin creams, birth control and insulin delivered through telehealth visits.
The new rules seek to allow greater access to essential telehealth for patients like those in rural areas while also balancing safety, an approach DEA Administrator Anne Milgram called “the expansion of telemedicine with a fence.”
The ease with which every American has access to certain drugs during the pandemic has helped many need treatment, but there are also concerns that some companies can take advantage of the loose rules and overprescribe drugs to people who do not need them, said David Herzberg. , a historian of medicine at the University of Buffalo.
“Both of these tensions have very good points,” Herzberg said. “You don’t want obstacles in the way of people getting prescriptions that they need. But any time you remove those obstacles, it’s also an opportunity to make a profit to exploit the lax rules and sell the drug to people who don’t need it.
U.S. overdose deaths hit a record in 2021, with about three-quarters from opioids during the crisis that was first created by drugmakers, pharmacies and doctors who pushed the drug to patients decades ago. But a grim toll from synthetic opioids like fentanyl surpassed prescription drug-related deaths that year, according to the Centers for Disease Control Data. Fentanyl is increasingly appearing on the illicit market, pressed into counterfeit prescription pills or mixed with other drugs.
The proposed rule deals a major blow to the booming telehealth industry, with technology startups launching in recent years to treat and prescribe medication for mental health or attention deficit disorders. The industry has largely benefited from a reprieve on in-person visits for medications caused by the pandemic, though some national retailers have stopped filling drug orders made by some telehealth apps over the past year.
The DEA has grown increasingly concerned over the past two years that some of these startup telehealth companies are not prescribing addictive substances like opioids or attention deficit disorder drugs, putting patients at risk, DEA officials told The Associated Press on Friday.
The official said the agency plans to enact new rules before the public health emergency of COVID-19 expires on May 11, which would put an end to the already lax rules. That could mean people who can get care from doctors hundreds of miles away should start making plans for in-person visits with doctors now, said Boston-based attorney Jeremy Sherer, who represents telehealth companies. Patients will have six months to visit a doctor when the regulations are implemented.
“Providers and patients need to know how the treatment will progress and whether, if the public health emergency ends in May, if they need to find a way to visit people before continuing. treatment, and it can be a real challenge,” he said.
Many states have moved to restore restrictions on telehealth care across state lines. As of October, nearly 40 states and Washington, DC, have ended emergency declarations that make it easier for doctors to see patients in other states.