Controlled substances have become a little less regulated during the pandemic. This has benefited both patients (for health) and telemedicine startups (for revenue).
Due to regulatory changes, some potentially addictive drugs, such as buprenorphine and Adderall, are now available online for patients. Given the shortage of qualified physicians to treat some of the behavioral health conditions associated with these drugs, such as opioid use disorder and attention-deficit/hyperactivity disorder, doctors online, if It is a big change to be able to prescribe over the phone depending on the situation. But there are both good and bad sides to making medicines more accessible, as they are often dispensed without a treatment that increases a patient’s chances of success.
Before the pandemic, patients could travel hours for addiction care, said Emily Behar, director of clinical operations at Ophelia, a New York startup that serves opioid addicts. Alternatively, patients may struggle with multiple jobs or lack of childcare. Such disorders made continuing care difficult.
“How do you reach them?” she asked.
Neeraj Gandotra, Ph.D., chief medical officer of the Department of Substance Abuse and Mental Health Services, agonizes much of the behavioral health sector, which is complicated by the reality that most patients with opioid use disorders go untreated. This is the problem that is causing the problem.
Increased access to telemedicine is beginning to provide answers. Startup executive her Behar says patients can see specialized healthcare providers at their convenience. Many in the industry say fewer missed appointments.
The startup secured solid funding — about $68 million, According to Crunchbase, an industry database — but addiction professionals and online prescribers of controlled substances are a mixed group. Others are large start-ups that have come under scrutiny from news media and law enforcement for alleged sloppy prescribing practices.
The influx of new providers has been attributed to relaxed requirements born of pandemic-era necessities. To help patients receive treatment while maintaining physical distancing, the Drug Enforcement Administration and his SAMHSA have waived restrictions on telemedicine for controlled substances.
However, it is unclear whether these changes will last. The federal government is slowly working to codify new rules for prescribing controlled substances in light of the healthcare system’s experience with the pandemic.
On December 13, SAMHSA issued a proposal to codify telemedicine regulations for opioid treatment programs, but this would affect only a portion of the sector. The process for individual health care providers to register to prescribe buprenorphine remains open, at least until the DEA issues a rule. can” Office Foley & Lardnerheadquartered in Milwaukee.
Congress has also tweaked regulations on buprenorphine, repealing a long-standing policy of limiting the number of patients each provider can prescribe. A major regulatory domino.
Additionally, pharmacies are becoming more skeptical of telemedicine prescriptions, especially from start-ups. Patients have become accustomed to using telemedicine to fill and fill prescriptions for some controlled substances such as Adderall, which is primarily used to treat ADHD.Ah lack of adderall Impacting access for some patients. But now some pharmacies refuse to fill those prescriptions.
Cheryl Anderson, who has ADHD in Pennsylvania, said she looked for online options because of her tight schedule.
“My husband is out of town so often that I don’t have someone to make sure I see the baby to visit him,” she said. was. Telemedicine has helped her about halfway through 2022. Previously, the DEA and state governments imposed strict rules on obtaining controlled substances from online pharmacies.
But in September, after a doctor wrote a replacement prescription, she received a call telling her that her local pharmacy would not dispense the drug if the prescription came from telemedicine. Other local pharmacies she called took the same position.
These denials seem to reflect widespread cultural shifts in attitudes. Patients and politicians welcomed telemedicine in the early days of the pandemic, but at first it was not only safer, but also more convenient, potentially extending care to unprofessional rural areas and neighborhoods. But a hint of skepticism creeps in.
The telemedicine boom has attracted shady actors. Especially in the behavioral health market, “a lot of people saw an opportunity to do something less than conscientious,” said Michael Yang, managing partner at venture capitalist firm OMERS Ventures. Skeptical media reports have surged with reports of start-ups allegedly shotgunning prescriptions for mental health conditions without monitoring patients taking those drugs. increase.”
According to Matt Morrison, owner of Gibson’s Pharmacy in Dodge City, Kansas, these startups are troubling local pharmacists.
Pharmacists have multiple responsibilities related to prescriptions, he said. Make sure incoming prescriptions are from legitimate doctors and relate to actual health conditions before fulfilling orders. According to Morrison, the industry’s sense is that prescriptions from startups are difficult. They may come from distant providers that pharmacists cannot easily contact.
These fears make addiction treatment difficult. Convincing pharmacists to fill prescriptions is one of her biggest administrative duties for Ophelia, he says Behar. Still, moving online helped.
“Telemedicine fills the gap,” said Josh Raftigis a founding member of CA Bridge, an Oakland, California-based program that helps emergency department patients begin treatment for substance abuse. The supply of health care providers was not sufficient to meet demand. “Generally, there is a lack of access to outpatient care. Now all they need is a phone call and a trip to the pharmacy.”
Providers say the treatment is more efficient for both patients and providers. “Most of our patients prefer the telemedicine experience,” he said. “Telemedicine appointments are more efficient.
Established organizations have also reported success. His Geisinger, a large mid-Atlantic health system, said 94% of its participants in one obstetrics-focused program were compliant, spokesman Emile Lee said. says.
Launched just before the pandemic, Ophelia hoped to treat patients both in-office and online. “We have an office in Philadelphia that we never used,” she said. Now, every few months in anticipation of the end of state and federal public health emergencies, the company strives to ensure that the termination of related looser rules does not disrupt patient care.
Permanent regulation by the DEA could make the future of online therapy more clear. What the agency’s rule to create a registration process for providers interested in prescribing controlled substances online says “is anyone’s guess,” says trade group Faegre Drinker, an expert in telemedicine. Executive Elliot Vice said the rule has been on hold for years. “It’s puzzling to see this still not working.”
The agency, who declined to comment specifically for this article, pointed to previous statements praising increased access to medication-assisted treatment.
“We shouldn’t change the telemedicine rules,” said Luftig. “In terms of access to our community, this is the scariest thing. It will be an immense disaster.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of his three major operational programs in the United States, along with policy analysis and polling KFFMore (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the public.
