DEA Proposes Limits on Prescribing Controlled Substances via Telemedicine

The federal Drug Enforcement Administration (DEA) recently published proposed rules that would reverse some telemedicine prescribing flexibilities offered during the COVID-19 public health emergency.

Prior to the public health emergency, a medical practitioner generally had to conduct an in-person examination before prescribing controlled substances. To ensure that patient therapies remain accessible during the emergency, DEA-registered practitioners have been allowed to use telemedicine in place of in-person evaluations to prescribe Schedules II through V controlled substances. This allows authorized practitioners to prescribe buprenorphine, a medication used to treat opioid use disorder, to new and existing patients via telemedicine, including telephone consultations. These flexibilities will end with the expiration of the public health emergency without action from the federal government.

The DEA’s proposed rules, published March 1, would discontinue medical practitioners’ authorization to prescribe controlled substances via telemedicine for patients who have never received an in-person exam, except for an initial 30-day supply of Schedules III through V non-narcotic controlled medications or buprenorphine for the treatment of opioid use disorder.

Noting concerns of diversion of buprenorphine — non-prescribed buprenorphine use — and misuse, the proposed rule would establish additional requirements for prescribing medications for opioid use disorder via telemedicine. Under the proposed rules, a practitioner must review the prescription drug monitoring program in the state where the patient is located prior to prescribing; conduct a medical exam in person or in the presence of another DEA-registered practitioner; and comply with comprehensive recordkeeping requirements.

Arkansas rules place restrictions on prescribing controlled substances via telehealth. A provider may not prescribe Schedules II through V controlled substances without seeing the patient for an in-person exam unless the practitioner knows the patient and the patient’s relevant health status through an ongoing personal or professional relationship; has established a relationship with the patient through consultation or referral; or is acting in an on-call or cross-coverage situation.

Arkansas has no exception for prescribing an initial supply of buprenorphine before a professional relationship has been established. The federal Controlled Substances Act requires that the practice of telemedicine involving controlled substances be conducted ‘‘in accordance with applicable federal and state laws,’’ meaning that the federal exception does not apply in Arkansas.

Telemedicine is a strategy to overcome numerous barriers that limit uptake of buprenorphine for opioid use disorder, including limited provider access, long wait times for treatment, stigma regarding drug use, and competing priorities. According to a 2022 study published in JAMA Psychiatry, receiving opioid use disorder-related telehealth services was generally associated with beneficial outcomes, including continued medication treatment and lower risk of overdose.

Historically, Arkansas ranks high among opioid dispensing states. In 2020, 546 drug overdose deaths occurred in Arkansas. The restrictions that would be established by the DEA’s proposed rules could set back the progress made in assisting those who need treatment for opioid use disorder.