Telehealth Can Help Us Combat The Opioid Crisis

posted by American Telemedicine Association

on March 18, 2019

As the opioid crisis devastates the United States, particularly in rural areas, telehealth can play a crucial role in reducing opioid misuse and abuse and to reduce opioid-related deaths.

  • Digital health solutions can help patients, providers, and families virtually manage many aspects of substance use disorder treatment.
  • Telehealth helps improve data sharing, which can help prevent multiple prescriptions from multiple doctors being filled for these highly addictive drugs.
  • Telehealth empowers substance use treatment facilities with additional provider capacity to serve more patients.

However, there are still barriers to fully incorporating telehealth and enhancing patient access. In an effort to stop Internet “pill mills” that dispense powerful painkillers for non-medical reasons, The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (“Ryan Haight Act”) also resulted in an unintended consequence. The Ryan Haight Act requires that, in most cases, a telehealth provider must conduct at least one in-person medical evaluation of a patient before remotely prescribing any controlled substances. Unfortunately that means patients cannot get medication assisted treatment (MAT) from legitimate telehealth providers who engage in remote prescribing.

To solve for this, a provision for a special registration for telemedicine was promised in the Ryan Haight Act, which is expected to take effect no later than Oct 24, 2019.

While the details of this special registration are still unknown, many groups, including the American Telemedicine Association (ATA), are committed to advancing telehealth intervention for patients with pain and for those suffering from substance use disorders.

Recently, the ATA submitted recommendations to the Drug Enforcement Administration (DEA) on how to design a registration process that would allow for MAT via telehealth, while also providing the various medical disciplines an avenue to expand access to quality care through telehealth. Our recommendations include:

  1. Update the current DEA registration process to specify distinctions between traditional and telehealth prescribing privileges.
  2. Allow both sites and prescribers to register for telehealth.
  3. Allow for a public comment period within the one-year timeline for special registration activation.
  4. Ensure that telehealth special registration is not restricted to any single discipline.
  5. Allow telehealth prescribers to apply for DEA registration numbers in multiple states at once.

Telehealth offers promise to expand needed services to remote and rural areas. The technology can be used to deliver appropriate pain treatment, behavioral health, and substance use disorder treatment to patients in need. However, policy and advocacy opportunities exist, including working with the DEA and other stakeholders to align priorities, to expanding telehealth as a viable, affordable option to access high-quality care.

By Tania S. Malik, J.D., chair of the Telemental Health Special Interest Group for the American Telemedicine Association (ATA); Olivia C. Boyce, MPH, co-chair of the ATA Workgroup on Controlled Substances Prescribing via Telehealth

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