APA: DEA telehealth guidelines should facilitate access to controlled substances

Key takeaways:

• The American Psychiatric Association urged the Drug Enforcement Administration to ensure access to controlled drugs via telehealth.
• The organization also recommended fewer prescribing and telehealth limitations.

The American Psychiatric Association has recommended the Drug Enforcement Administration ensure access to buprenorphine and other controlled drugs through telehealth to combat the opioid epidemic and the national mental health crisis.

In a letter addressed to DEA Administrator Anne Milgram, JD, the APA advised the DEA to reduce the proposed limitations for prescribing controlled substances, such as requiring referring practitioners to register with the DEA.

Other recommendations include reducing administrative requirements and restrictions on prescribing when temporarily out of state, eliminating the regulation of clinical decisions and clarifying inconsistencies in the proposed rule.

“We caution DEA in taking too many steps backward, re-imposing unnecessary limitations on the practice of medicine during an opioid public health emergency and nationwide mental health and access to care crisis,” Saul M. Levin, MD, MPA, FRCP-E, FRCPsych, APA CEO and medical director, wrote in the letter. “Fifty-five percent of U.S. counties have no psychiatrists, and 130 million people live in areas with a shortage of mental health providers. DEA has the opportunity to get the balance right by finalizing rules that facilitate, rather than prevent, access to high-quality care.”

In a second letter, the APA focused on access to buprenorphine, which is the only FDA-approved Schedule II narcotic for opioid use disorder. In addition to its recommendations for controlled substances, the APA urged the DEA to remove in-person prescribing requirements for buprenorphine.

“By requiring an in-person examination within 30 days of initiation of buprenorphine, the proposed rule is not just suboptimal but potentially fatal for the most vulnerable populations,” Levin wrote. “At-home induction of buprenorphine has become the standard of care to achieve optimal outcomes. There is no evidence that telemedicine prescribing during the COVID-19 public health emergency increased diversion or negative outcomes associated with access to controlled substances. In fact, initial data indicates that telehealth initiation in OUD care increased retention in treatment.”

References:

• Docket No. DEA-407. Drug Enforcement Administration. https://www.dea.gov/sites/default/files/2023-02/Telemedicine%20%28DEA407%29.pdf.
• Docket No. DEA-948. Drug Enforcement Administration. https://public-inspection.federalregister.gov/2023-04217.pdf?1677526230.
• Levin SM, et al. Re: Expansion of Induction of Buprenorphine via Telemedicine Encounter (Docket No. DEA-948). https://www.psychiatry.org/getattachment/4428f9f0-8fdf-4976-a9b8-e266b2cd5d4d/APA-Letter-to-DEA-Buprenorphine-Telemedicine-Docket-No-DEA-948-03312023.pdf. March 31, 2023.
• Levin SM, et al. Re: Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation (Docket No. DEA-407). https://www.psychiatry.org/getattachment/d00e8ef0-5e46-4f21-92c1-f620d23d250a/APA-Letter-to-DEA-Telemedicine-Prescribing-Docket-No-DEA-407-03312023.pdf. March 31, 2023.