The Covid-19 public health emergency greatly expanded use of telehealth at a time when people needed to stay at home to reduce infection. While some telehealth flexibilities have been extended to 2024, others will be expiring when the public health emergency ends in May, including for opioid treatment. This will have dangerous implications for those battling substance use disorder, experts are warning.
The Ryan Haight Act of 2008 requires that a practitioner must conduct an in-person medical evaluation before prescribing controlled substances via telemedicine. This includes treatments like suboxone to tackle opioid use disorder. The public health emergency temporarily waived this act, meaning patients could access these treatments without having to travel for an in-person medical visit. The expanded telehealth flexibilities were shown to reduce the risk of opioid use overdoses, and patients treated via telehealth were more likely to stick with treatment, a recent study found.
“We now have this very large cohort of patients … that have been able to maintain access to care, maintain that treatment,” said Kyle Zebley, senior vice president of public policy at the American Telemedicine Association. “That’s all being jeopardized by the coming end to the public health emergency.”
Providing this treatment virtually is especially beneficial for those in treatment deserts, said Ankit Gupta, CEO of Bicycle Health, which provides opioid use disorder treatment through telemedicine. About 40% of counties in the U.S. don’t have a single provider that can prescribe suboxone. Telehealth also helps those with busy work schedules and can bridge the stigma gap, he added.
“It’s hard to take time off of work and go get treatment,” Gupta said. “For these patients, they could step out of work, into their car with a telemedicine appointment during their break and go back to work. No one needs to know. Then on the way back home, again, they stop by the pharmacy, pick up the prescription, and no one at home needs to know. This allows them to obviously stay in treatment, keep their job, keep their family lives. Over time, they can work toward long-term recovery.”
Sam Arsenault Wilson, chief quality officer and co-founder of Confidant Health, echoed Gupta’s comments. Confidant also prescribes opioid use disorder treatment via telemedicine.
“It would be a disaster if the PHE ended without rules being established to continue telehealth access to medications for addiction treatment,” Wilson said. “Patients across the country are stabilized in care and on a path to recovery with providers who they’ve established relationships with, discontinuing this care jeopardizes people’s lives. Additionally, local capacity could simply not absorb demand in many parts of the country.”
There has already been a taste of what could happen if the public health emergency ends without action being taken in the opioid treatment space, Gupta said. Last year, Alabama instituted a new rule that required an in-person exam for the prescription of controlled substances. Bicycle Health had about 500 patients in the state and flew its doctors to Alabama to perform in-person examinations for a week. The company was able to help about 200 to 300 patients, but still had many left over.
“These kinds of disruptions in care are just going to be magnified by the tens of thousands,” Gupta said. “Any disruption in care in this population could have adverse health effects. It could lead to relapse, it could lead to overdose, especially with fentanyl being in the drug supply.”
Alabama’s decision could be due in part to some providers’ negligent prescribing practices, said Dr. Brian Clear, chief medical officer of Bicycle Health, in a recent MedCity Influencers post. This includes Cerebral, a telemedicine company that is facing scrutiny for its prescribing practices of Adderall. Due to the controversy, Cerebral’s CEO resigned and the company also stopped prescribing controlled substances as a treatment for ADHD to new patients. While it’s necessary to stop harmful actions in the space, that doesn’t mean all telemedicine providers should restricted, Clear argued.
There is hope that something could change before the end of the public health emergency, the experts said. The Drug Enforcement Administration (DEA) could establish a special registration rule, which would allow providers to register with the DEA to prescribe controlled substances via telemedicine. The DEA has said it would do this since 2009, but has yet to fulfill its promise.
Another possibility is the passing of a bill currently sitting in the Senate that would extend the waiver for the Ryan Haight Act another couple of years. Additionally, the waiver could be connected to the opioid public health emergency, which has been in effect since 2017.
“It’s a predictable public health crisis, but it’s also a preventable one,” Zebley said. “It will be unacceptable if we get a place by May 11 where we leave some of our most vulnerable fellow citizens out in the cold.”
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