With the COVID-19 public health emergency set to expire on May 11, 2023, the U.S. Drug Enforcement Agency recently released proposed new telemedicine rules to provide continuity of care for patients needing buprenorphine and Schedule III-V controlled medications. The California Medical Association strongly supports the use of telemedicine to initially prescribe buprenorphine for the treatment of opioid use disorder, as it is extremely important to prevent and eliminate the tragic drug poisonings and overdoses occurring across the nation. However, CMA has serious concerns that other parts of the proposed rules will limit access to care for our most vulnerable patients and reverse the gains we made through telemedicine during the COVID-19 pandemic. CMA is urging the DEA to adopt a more balanced approach that ensures appropriate patient access to medically necessary medications via telemedicine, while still protecting against abuse.

CMA urges DEA to extend the 30-day requirement for an in person medical evaluation to 180 days, for buprenorphine, as well as for schedule III – V controlled substance prescriptions. It is not realistic for patients—especially those with opioid use disorders or other serious medical conditions—to obtain an in-person appointment with a physician within 30 days, particularly in underserved and rural communities where there are physician shortages. There are also many barriers to in-person medical exams, including the physical or mental condition of the patient, the availability of physicians, transportation difficulties, financial hurdles related to the cost of transportation and parking, or that patients, their caregivers, or parents must take time off work to visit a physician in-person. CMA is also urging DEA to allow an initial telehealth prescriptions for schedule II controlled substances, with a similar 180 day requirement for an in person medical evaluation.

CMA is also urging DEA to provide exceptions to the in-person physician medical evaluation requirements for patients who are receiving palliative care, end-of-life care, including hospice, cancer care, or who are homebound. These patients are extremely fragile and their medical conditions (both physical and mental) do not allow them to easily access a physician’s office. Telemedicine is also a safe way to protect these vulnerable patients from contracting infectious diseases outside their homes. These patients pose a reduced risk for abuse given their clear need for controlled medications.

While CMA appreciates that the rule allows initial controlled substance prescribing via telemedicine for physicians and patients who have had a prior in-person medical evaluation, we strongly urge DEA to allow prior telemedicine encounters to also meet the requirements. Many physician-patient relationships were formed via telemedicine during the COVID-19 pandemic, particularly for the elderly, the disabled, the sick, and physically or mentally homebound patients. We believe these are legitimate relationships that should be recognized by the DEA and given an exemption from the in-person exam.

For more details, see CMA’s letter to DEA.