Last Updated: Oct 12, 2023
On September 12th and 13th, the DEA hosted listening sessions revolving around the type of safeguards needed for providers to prescribe controlled substances by way of telemedicine without the in-person requirements. These sessions involved the virtual and in-person testimony of fifty-five individuals who ranged from physicians, health administrators, experts, advocates, patients, and government representatives (DEA, 2023a).
These testimonies are to assist in the development of a final rule that could determine the fate of the Ryan Haight Act. The hope is for legislation to be developed by Fall 2024. The Ryan Haight Act requires physicians to have one in-person evaluation prior to prescribing controlled substances by way of telemedicine. Originally, this act was waived until November 11th, 2023. The DEA in conjunction with SAMHSA created a temporary rule that would extend the Telemedicine Flexibilities regarding the prescribing of controlled substances as they were in place during the COVID-19 Public Health Emergency (DEA, 2023b). This would have allowed a provider-patient relationship that was established prior to November 11th, 2023, to be given a one-year grace period where the telehealth flexibilities would then be governed until November 11th, 2024 (DEA, 2023c). As an update to the first temporary rule, the DEA because of the listening sessions created another temporary rule that would extend the telehealth flexibility and waive the Ryan Haight Act through December 31st, 2024, regardless of when the relationship was established (DEA, 2023d).
The purpose of the listening sessions was to receive public comment on the three proposed rules from March 2023 along with what safeguards should be in place to remove any possible drug diversion occurring in the event the telehealth flexibilities were made permanent. These sessions provided testimony both for and against modifying the Ryan Haight Act. Examples of representatives from organizations that testified were:
- Alliance for Connected Care
- The American Academy of Family Physicians
- The American Psychiatric Association
- The American Society of Addiction Medicine
- The American Society of Consultant Pharmacists
- The American Telemedicine Association
- Investigations Medicare Drug Integrity Contractor
- Johns Hopkins
- National Association of Community Health Centers
- PharmD
- Yale School of Medicine
Some of the testimony suggested the creation of another DEA license that was only committed to telehealth-only prescribing as a way for pharmacies to identify the type of licensure. Other testimony was against the use of creating another licensure for telehealth. Another suggestion was the method being used for drug screening patients by way of telehealth and limiting the type of controlled substances that are being prescribed under the use of telehealth without the in-person requirement.
There were some who testified and spoke on data from research studies their organization performed or was in the middle of performing. The deputy administrator and assistant deputy administrator both asked for the study to be sent to them if/once completed. Those who testified were required to provide and spell out their first and last name as the testimony was being transcribed so that it may be involved in the determination of a final rule on this matter (DEA, 2023a). It was made clear at the beginning of both sessions that given the transcribing, presentations or visual aids would not be accepted during the testimony itself. The visual aids could be submitted just not presented. The deputy administrator and assistant deputy administrator did perform follow-up questions during some of the testimonies but made it clear that there would not be a long discussion on each testimony. The purpose of the follow-up questions was to increase clarity and understanding of the testimony that was provided. The listening sessions were recorded and can be found here.
The next steps will involve the DEA and SAMHSA coming together and determining how to proceed with their next legislation to address this situation (DEA, 2023a). They plan to open a written comment period for this rule. The hope is to release a final rule regarding the prescribing of controlled substances by way of telehealth without the in-person medical evaluation by Fall 2024. The current temporary rule has been extended through December 31st, 2024, because of these sessions (DEA, 2023d).
References:
- The Drug Enforcement Agency. (2023a). Telemedicine listening session. Telemedicine Listening Session. https://deadiversion.usdoj.gov/Telemedicine_listening_session.html
- The Drug Enforcement Administration (DEA). (2023b). Practice of Telemedicine: Listening Sessions; Notice of Meeting. DEA. 88 Fed Reg. No. 150, 16889 (August 7, 2023). https://www.govinfo.gov/content/pkg/FR-2023-08-07/pdf/2023-16889.pdf
- The Drug Enforcement Administration (DEA). (2023c). Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. DEA. 88 Fed Reg. No. 90, 09936 (May 10, 2023). https://www.govinfo.gov/content/pkg/FR-2023-05-10/pdf/2023-09936.pdf
- The Drug Enforcement Administration (DEA). (2023d). Second Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. DEA. 88 Fed Reg. No. 194, 22406 (October 10, 2023). https://www.govinfo.gov/content/pkg/FR-2023-05-10/pdf/2023-09936.pdf