It can be difficult for patients with substance use disorders, depression, anxiety, or obsessive-compulsive disorder to seek care and commit to a regular schedule of behavioral health care visits. However, telehealth and telepsychiatry have vastly enabled both access and compliance with care. That being said, medication should not be prescribed without proper oversight and care, regardless of whether the doctor is assessing the patient online or in person.
During the COVID-19 pandemic, the Drug Enforcement Administration (DEA) relaxed its online prescribing rules to better accommodate what had become “the new normal.” Now, with the pandemic behind us, the DEA is reconsidering rules that will require providers to see their patients at least once in person, before prescribing medication during telehealth visits. This is to ensure that prescription medication is properly administered.
This includes controlled medications such as stimulants, sedatives, opioid painkillers, and anabolic steroids, which are potentially addictive. The DEA Controlled Substance List (PDF format) is a helpful resource for providers, to help them determine what schedule a drug is on and whether it is classified as a narcotic.
The relevant drugs impacted by this shift are on Schedules III–V and have — at most — a moderate potential for physical and psychological dependence. These include AMBIEN®, Ativan®, ketamine, Valium®, Xanax®, and many others. Drugs that are on Schedules III–V but are also classified as narcotics, such as tramadol (Schedule IV), also cannot be prescribed without at least one in-person appointment. In addition, after a 30-day prescription is exhausted, an in-person appointment is now required before a provider can prescribe additional controlled substances.
The DEA’s proposal specifically applies to video and audio-only telehealth consultations in which the practitioner has never met the patient in person and the patient was not referred by a practitioner who met them in person.
The proposed rules won’t impact telehealth consultations if providers don’t feel it necessary to prescribe controlled medications. They also won’t impact any scenarios in which the practitioner previously examined the patient in person, or if the patient was referred by a medical practitioner who previously saw the patient in person.
After getting more than 38,000 comments on the proposed changes, regulators recently agreed to extend the current regulations, which do not require an in-person appointment first, until November 11, 2024.
As providers prepare for these regulations, they should consider how their e-prescribing services and documentation of care must be modified. There are approaches to solve that problem by ensuring that behavioral health clinicians who do prescribe online are following standards of measurement-based care, the systematic administration of symptom rating scales and other assessment tools to track patient progress, and documenting patient progress over time. Ideally, prescriptions should be coupled with a dedicated therapy plan and schedule.
Measurement-based care allows providers to demonstrate effectively that they’re documenting objective evidence of better behavioral health outcomes before and during prescribing medication. And, while measurement-based care might sound complicated, it can be simple if clinicians focus on routinely collecting short patient self-report questionnaires and incorporating the results into their treatment plan. Following standards of measurement-based care can support patients and clinicians and help produce better health outcomes.
Taking this approach can help ensure any new regulations do not place negative restrictions on the many benefits that telehealth offers behavioral health care, including greater accessibility and flexibility.
The pandemic urged the DEA to make changes in favor of telehealth psychiatric care that made the system better because it ultimately made behavioral health care more accessible to more Americans. As providers adjust their practices to meet these updated regulations, they should consider measurement-based care as a method for showing objective evidence for the efficacy of their care. This offers the best compromise between ensuring all channels for access remain open, while ensuring quality of care does not suffer.
Ram Krishnan joined Valant in 2020 as an experienced technology executive to lead the organization through its next stage of growth. His passion for listening to customers and building strong teams, coupled with his demonstrated ability to drive scalability, provides a solid foundation for Valant to grow as it discovers new ways to serve the behavioral health care market.