Senators Want Telemedicine Up Front In The Opioid Epidemic Battle

This article originally appeared on mHealth Intelligence by Eric Wicklund.

A group of senators is urging the Trump Administration to allow healthcare providers to use telemedicine to tackle the nation’s ongoing opioid abuse epidemic.

In a letter to Robert W. Patterson, the acting administrator of the U.S. Drug Enforcement Agency, the senators have asked that the agency expedite the process allowing providers to register to prescribe medication-assisted treatments via telemedicine.

The severity of the U.S. opioid crisis demands nothing less than immediate action on this issue,” said the letter, dated January 30 and signed by Sens. Claire McCaskill (D-Mo.), Lisa Murkowski and Dan Sullivan, (both R-Alaska).

The letter takes aim at the Ryan Haight Act, the landmark 2008 law that prohibits physicians from prescribing controlled substances electronically until they have conducted an in-person examination, or if they meet the federal definition of practicing telemedicine, which requires that the patient be treated by, and physically located in, a hospital or clinic which has a valid DEA registration; and the telemedicine practitioner is treating the patient in the usual course of professional practice.

At that time, Congress also gave the DEA the authority to create a “special registration” to allow providers to bypass those restrictions. The agency had signaled that it would make that rule part of its bylaws in 2015, but has yet to do so, despite lobbying from telehealth advocates.

President Trump declared the opioid epidemic a national public emergency last October, then extended that declaration for another 90 days just last month. That declaration gave the DEA authority to, among other things, enable the exemption.

But the agency hasn’t taken any action yet.

“The bar on telemedicine prescribing of anti-addiction medication will continue to impact rural Americans, who often live far from dedicated treatment centers and mental health professionals,” the senators wrote.

The senators are asking the DEA to “immediately move to expedite the rulemaking process” to enable providers to use telemedicine to prescribe opioid-based medication-assisted addiction therapies. They added that the new rule wouldn’t allow providers to generally prescribe controlled substances or bypass the normal process for “any other pain-related purpose that is not part of a medication-assisted treatment for opioid addiction.”

The crisis hits home for the three senators, whose two states include large swaths of rural land with little or no access to needed healthcare services – 98 of the 101 rural counties in Missouri have no licensed psychiatrists, while more than 80 percent of Alaska’s communities aren’t connected to a road system.

“We’re in the midst of a national opioid epidemic, and Missourians in rural communities are struggling to get the care they need,” McCaskill said in a press release accompanying the letter. “I’ll say it until I’m hoarse: This crisis requires an all-hands-on-deck approach, and one step the Administration can take right now to continue fighting the epidemic is to make it easier for rural Missourians addicted to opioids to get anti-addiction medication.”

In an interview with last August, Lisa Schmitz Mazur, an attorney with McDermott Will & Emery who specializes in telemedicine, telehealth and mHealth, said providers have been struggling to find a way to use telehealth and telemedicine to treat patients with addiction issues without running afoul of federal law.

Some states have passed legislation making that easier, she said, but federal law supercedes those efforts.

“It’s creating an environment where healthcare providers are not wanting to do this at all,” she said. “It has become too complicated.”

McCaskill, Murkowski and Sullivan are hoping the DEA can alleviate those complications.

“While practical steps have been taken and progress has been made, there is more that can be done, and more that should be done to address our nation’s devastating opioid epidemic,” Murkowski said in the press release. “I have said time and time again, this is an issue that transcends politics and its impacts are far-reaching. This rule change for expanding telemedicine access in a safe and controlled manner is another crucial step forward in addressing this epidemic and would ensure that controlled substances are dispensed in a tightly regulated and safe way.”

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