Controlled substances like Adderall will be allowed to be prescribed online into late 2024, U.S. health and drug officials said, reversing their earlier position that restrictions on the drugs would be reinstated as the pandemic eased.
Health-care providers can prescribe controlled substances online through Nov. 11, according an advance copy of a rule posted online Tuesday. In addition, practitioners who establish relationships with patients on or prior to that date can continue to prescribe controlled substances for an additional year.
The Drug Enforcement Administration, which regulates medications with potential for abuse, had planned on curtailing access to the drugs through telehealth. Remote prescribing was made more available at the start of the Covid-19 pandemic as a result of lockdowns that made doctors’ offices visits less accessible. But after significant pushback, the agency changed its mind and decided to keep the existing, relaxed policies in place for now.
“We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities for six months while we work to find a way forward to give Americans that access with appropriate safeguards,” DEA Administrator Anne Milgram said in a statement. The rule was issued jointly with the Health and Human Services Department.
Prior to the pandemic, controlled substances could only be prescribed online for patients who had previously gone to an in-person appointment with the same provider. The DEA waived that requirement as the pandemic shuttered doctors’ offices and clinic, making it easier for people with anxiety, attention-deficit/hyperactivity disorder and opioid use disorder to get medications that previously required many time-consuming, in-person appointments.
Relaxed regulations also led to the development of online companies that connected patients with providers to get these prescriptions. Some businesses have come under scrutiny by the federal government over their prescribing practices.
Easier access to controlled substances was seen as a temporary pandemic measure. But some medical and business organizations said the policy change made it easier to take care of patients and therefore should become the new status quo.
The American Psychological Association and the American Telemedicine Association think the current flexibilities should become permanent, representatives said after the DEA rule was released Tuesday.
“We’re hopeful there will be no imposition of inflexible, blanket, in-person requirements,” said Kyle Zebley, senior vice president of public policy at the ATA, said in an interview.
The American Medical Association commended the DEA’s extension without commenting on whether it should become permanent. Bobby Mukkamala, chair of the AMA’s substance use and pain care task force, said in a statement that telehealth prescribing of controlled substances is helpful because it makes it easier for patients to secure and attend appointments.
Earlier this year, the DEA proposed removing many of these flexibilities and gave the public 30 days to provide feedback. Advocacy groups pushed back, saying they feared that the February proposal was rushed and did not give telemedicine companies enough time to prepare and comply to new regulations.
The Biden administration received more than 38,000 comments on the proposed rules, according to a document to be published in the Federal Register.
Complying with the agency’s six-week window to return to pre-pandemic restrictions would have been untenable for providers, Zebley said in an interview earlier this month.
“We thought that 30 days was way too short of a comment period window to draft rules responsibly,“ Zebley said.
The short timeline may have played a part in the DEA’s decision to postpone new restrictions on prescribing, said Mimi Winsberg, cofounder at Brightside Health, an online therapy company.
“I think the DEA had no choice but to extend this ruling because they didn’t have time to process the over 38,000 comments they received on it,” Winsberg said in an interview. “They knew it wasn’t feasible.”
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Contributor: Ike Swetlitz and Ganny Belloni/Bloomberg