During the pandemic, controlled substances became somewhat less controlled. That benefited telehealth startups as well as patients (for their health) (to make money).
Due to regulatory reforms, patients can now access several potentially addictive drugs far more readily online, including Adderall and buprenorphine. Doctors’ new ability to prescribe online or, in some cases, by phone is a significant change, especially given the dearth of qualified medical professionals to treat some of the behavioral health conditions linked to these medications, such as opioid use disorder or attention-deficit/hyperactivity disorder. But having better access to the medications has both benefits and drawbacks because they are frequently prescribed without the complementary therapy that increases the likelihood that a patient will succeed.
According to Emily Behar, head of clinical operations for Ophelia, a New York start-up that helps people with opioid addictions, patients would frequently drive several hours before the pandemic for addiction treatment. In addition, patients might be having difficulty finding childcare or managing numerous jobs. These challenges make providing care challenging.
She questioned, “How do you get to those people?”
According to Dr. Neeraj Gandotra, chief medical officer of the Substance Abuse and Mental Health Services Administration, the problem is complicated by the fact that the majority of patients with opioid use disorder are not receiving treatment.
Increased telehealth accessibility is beginning to offer a solution. Behar, the startup executive, claims that patients can visit skilled practitioners whenever it is most convenient for them. According to many in the sector, fewer people are missing appointments.
Crunchbase, a business database, reports that the startup has received about $68 million in funding. However, the startup’s online prescribers of controlled medications are a mixed bag, including several addiction specialists. Some are nonprofit organizations, while others are sizable startups under investigation by the press and law enforcement for allegedly careless prescription procedures.
Due to the necessity of the pandemic era, regulations were reduced, which led to the influx of new providers. The Drug Enforcement Administration and SAMHSA lifted prohibitions on telehealth for prohibited medications to assist individuals in receiving care while remaining physically apart.
But it’s unclear if those modifications will stick. In light of the pandemic experience of the healthcare system, the federal government is working piecemeal to codify new regulations for dispensing banned medications.
A proposal to codify telehealth laws for opioid treatment programs was released by SAMHSA on December 13; nevertheless, only a portion of the industry is affected. The procedure for individual providers to register to prescribe buprenorphine has not been addressed, at least not until the DEA issues rules. According to Sunny Levine, a telemedicine and mental health attorney with the D.C.-based firm Foley & Lardner, the new regulations “bring us at least a little bit closer to where we need to go.”
Additionally, Congress changed the regulations governing buprenorphine, eliminating a long-standing provision that limited the number of patients that a practitioner could prescribe to. The DEA is ultimately the biggest regulatory domino that telehealth providers still need to see fall.
Additionally, especially from startups, pharmacies are approaching prescriptions for telehealth services with greater skepticism. Patients were getting used to filling and renewing their prescriptions for some banned narcotics, such Adderall, which is largely used to treat ADHD, via telemedicine. Some patients’ access to Adderall has been hampered by a supply constraint. However, several drugstores are currently refusing to fill those prescriptions.
One Pennsylvanian with ADHD named Cheryl Anderson claimed that due to her hectic schedule, she looked for internet choices.
She explained that she didn’t have a reliable babysitter so she could attend an in-person appointment because her spouse was usually out of town. Finding the time was difficult with three children. About half of 2022 was aided by telehealth. Previously, ordering banned medications through online pharmacies was subject to strict regulations from the DEA and state governments.
But in September, after her doctor had issued a refill prescription, she received a phone call informing her that if the prescription was obtained through telehealth, her neighborhood pharmacy would not be able to fill it. She called a few local pharmacies, and they all expressed the same opinion.
Those denials appear to be a reflection of a wider cultural attitude change. At the beginning of the epidemic, patients and lawmakers praised telemedicine, primarily for its safety but also for its improved convenience and capacity to extend care to remote areas and neighborhoods without specialists. However, hints of skepticism are beginning to surface.
The telemedicine boom drew questionable characters. Particularly in the behavioral health business, “you had a lot of folks who saw an opportunity to do things that were less than conscientious,” according to Michael Yang, managing partner at the venture financing firm OMERS Ventures. Media reports about startups that reportedly shotgun prescribe drugs for mental health disorders without monitoring patients getting those medications have been increasingly skeptical. It will calm down.
According to Matt Morrison, proprietor of Gibson’s Pharmacy in Dodge City, Kansas, the startups provide challenges for the area’s pharmacists.
He stated that pharmacists must fulfill a number of duties in relation to prescriptions, including verifying that incoming prescriptions are from reputable doctors and that they are tied to a real health issue before filling the order. Morrison claimed that there is a perception within the sector that startup prescriptions are challenging. They can originate from a far-off supplier that the pharmacist finds difficult to get in touch with.
These reservations make treating addiction challenging. One of the main administrative responsibilities for Ophelia is convincing pharmacists to complete prescriptions, according to Behar. The shift online has nonetheless been beneficial.
Josh Luftig, a founding member of CA Bridge, a program based in Oakland, California, that aids people in emergency rooms begin treatment for substance abuse, said: “Telehealth fills in the gaps.” There weren’t enough healthcare professionals to handle the demand. “Access to treatment in the outpatient context has often been poor. All they still need to do is find a phone and a drugstore.”
According to providers, treatment is more effective for both patients and providers. The majority of our patients, he claimed, prefer to use telemedicine. “The telehealth consultations are more productive. Each participant’s capacity is increased.”
Successful initiatives have also been reported by reputable institutions. Geisinger, a sizable mid-Atlantic health system, reported that 94% of participants in one program with an emphasis on pregnant women complied, according to spokesperson Emile Lee.
Ophelia, which launched right before the epidemic, planned to provide both in-person and online patient care. She said, “We have an office in Philadelphia that we’ve never used. In order to prevent disruptions in patient care caused by the expiration of the accompanying loosened rules, the company now works diligently every few months in preparation of the conclusion of state and federal public health emergency.
Permanent DEA standards may bring more clarity to the future of internet therapy. Anyone’s guess as to what the agency’s rule, which would establish a registration procedure for physicians interested in prescribing controlled medications online, will say, according to Elliot Vice, a telehealth executive with the trade association Faegre Drinker. That law has been on hold for many years. It is perplexing to see this stand still.
The organization cited earlier statements applauding more access to medication-assisted treatment when it declined to comment specifically for this issue.
According to Luftig, the regulations governing telehealth shouldn’t change. “Accessibility-wise, it would be the most dreadful thing for our communities. It would be a complete catastrophe.”
A nationwide news organization called KHN (Kaiser Health News) delivers in-depth reporting on medical topics. KHN is one of the three main operating programs at KFF, together with Policy Analysis and Polling (Kaiser Family Foundation). KFF is a funded NGO that informs the country about health-related concerns.
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