Changes to how we’ve been able to get prescriptions online the last few years have been put on pause, allowing pandemic-era loosened restrictions on some medications to remain in effect for at least an additional six months.
In late February, the US Drug Enforcement Administration announced rule changes that affected online prescriptions of certain drugs that are more strictly regulated by the government once the public health emergency for COVID-19 expired, which happened Thursday. These include some medications for ADHD and opioid addiction.
But a “record” number of public comments from doctors, patients and people who believe requiring in-person consultations puts undue burden on those who wouldn’t otherwise have access to medication have made the DEA and the Substance Abuse and Mental Health Services Administration reconsider — at least for the time being, according to a news release from the agencies posted Tuesday.
Now, the pandemic-era rules for getting a telemedicine prescription will remain in effect through November. Practitioner-patient telemedicine relationships established up until November this year will be extended for an additional year, according to the news release.
“The DEA received a record 38,000 comments on its proposed telemedicine rules. We take those comments seriously and are considering them carefully,” DEA administrator Anne Milgram said in the release. “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.”
In a nutshell, the DEA’s rules for controlled medication prescriptions via telemedicine were to require patients who were prescribed them during the pandemic to see a provider in person at least once to maintain their prescription. New patients would still be able to get a month’s supply for many of these drugs, but would then need to see their provider in person.
The pandemic-era telemedicine boom has been a silver lining for many people over the last three years, at least from a health care access perspective. Along with the burst of new companies offering online health care, restrictions on how providers could treat and prescribe controlled medications were loosened, removing the need for a patient to see a doctor face to face for some key medications, including those for mental health and opioid addiction.
The DEA proposes that the new rules, which include specific record-keeping requirements by the telehealth provider, may help curb misuse of controlled medications, which include popular drugs such as Adderall. While there are blind spots in telemedicine, broader telemedicine access has provided health care access for those who don’t have an easy time meeting with a provider in person, including people who live in rural areas or who have difficulty getting time off from work. While officials are keeping some aspects of telemedicine open, some experts worry that adding back in-person requirements or referrals will be a barrier to many people who’ve benefited from telemedicine.
If or when they’re finalized, the proposed rules will change care for some patients, though there are things you can do to prepare.
Here’s what we know about the DEA’s proposed telemedicine rules, keeping in mind that nothing has changed now that pandemic-era rules have been extended and that the proposed rules may change.
During the pandemic, many people embraced telemedicine services, including for increased access to health care for those who may not have it otherwise.
What the DEA’s proposed rules would (and wouldn’t) affect
Prescriptions for many common medications and drugs would stay available via online consultation, regardless of what the DEA and SAMHSA decide between now and November. Common medications that people take to manage a health condition (insulin, blood pressure medication, birth control and more) won’t be affected.
It’s also important to remember that while the DEA does have a published draft of its proposed rules, it’s extended the time it’ll take them to go into effect, suggesting it may make some changes to reflect public outcry.
If the rules do change, whether medications are affected will depend on how they’re scheduled: The DEA classifies them based on its perception of the potential for misuse and how the drug is used medically. Schedule I drugs are the most restricted class and include drugs you’d have to buy illegally in many circumstances, including cannabis, LSD and more. At the other end, schedule V drugs include some painkillers and cough medicines, such as Robitussin.
If the proposed rules go into effect and you have a prescription for a schedule II drug, which includes Adderall and Ritalin, you’ll need to see a provider face to face in order to fill, or refill, a prescription. If you haven’t had a non-telemedicine visit with a provider, you’ll need to get one to continue your treatment.
For some common anxiety medications, at-home ketamine treatment, drugs for opioid misuse and more, new patients will be able to get a month’s supply of medication (30 days) but will need to find an in-person provider to continue their treatment and get a refill. This includes drugs like Ambien, Xanax and buprenorphine. Testosterone, which many transgender patients take as a part of their hormone therapy, is also controlled and will require an in-person appointment. Estrogen is not a controlled drug.
Here’s a list of controlled substances so you can find out which class your medication is in. Here is a graphic the DEA has for its proposed rule changes. To be certain about how your medication is classified and how the rules will affect your particular case, check with your prescriber.
Many common medications you’d be prescribed at an urgent care or by your family doctor (such as antibiotics, birth control and insulin) are not controlled as strictly by the government and won’t be affected by the changed rules, so you’d still be able to get them via telemedicine.
When the rules were first proposed by the DEA, there was a grace period for prescriptions written during the COVID-19 pandemic. Because the rules have already been extended an additional six months, it’s unclear right now what type of grace period will be in place (if any) once the DEA finalizes new ones months from now.
Changes in opioid use disorder medication
Buprenorphine is one of a few medications people can take to manage opioid use disorder, including addiction to heroin. It’s essentially a weaker version of methadone. If the rules go into effect eventually, people who get their first prescription for buprenorphine will need to find an in-person provider within a month in order to keep their treatment – something that many addiction specialists have said poses a barrier to critical treatment.
How will this affect online ADHD treatment or mental health medications?
During the pandemic, there was a burst of online ADHD diagnoses and prescriptions, particularly among younger women. Sites including ADHD Online, Cerebral and Done will all have to abide by the DEA’s rules for new prescriptions, should they go into effect.
How to find an in-person provider
Whatever the finalized DEA rules will be for telemedicine, it’s good to know how to find an in-person provider. And without the right connections, finding a provider that’s able to prescribe controlled medication can be tricky, and expensive. As a good first step, contact your insurance company if you have health insurance and ask them to help guide you. You can also follow these medication-specific tips below.
Finding an ADHD provider
Additude Magazine, a publication for people with ADHD, published a guide for what patients should consider when looking for a provider. It’s also worth noting that not all ADHD medications are stimulants, and non-stimulant types will have different rules than Adderall, for example.
General tips finding a mental health provider
Because the DEA’s rules apply to the prescriptions of drugs, mental health support will still be available through many telemedicine or online therapy companies – whether you’re looking for help with anxiety, depression, ADHD or something else. Here’s a list of the best online therapy options out there right now, as well as best psychiatry services.
Help finding opioid use therapy
Buprenorphine can be prescribed at a physicians’ office, and new patients will be able to get a month’s supply if they start treatment online if the DEA’s post-pandemic rules are in place. Then you’ll need to find another provider to keep with the treatment.
If you don’t have a primary care doctor, checking with your local health department would be a great first step. If you started a prescription during the pandemic, your buprenorphine prescription will be carried for the additional 180 days, which means you’ll have a few extra months to find an in-person appointment. Big cities might have a directory of places and phone numbers especially for opioid addiction treatment, like this one in New York City.
People living in rural areas with fewer health care centers may have to travel longer distances to find health care. To help narrow down your search, the US Department of Health and Human Services has a provider search. To use it, type in your ZIP code and distance you’re able to travel.
For help finding hormone therapy
Patients taking testosterone for gender-affirming care will also need to abide by any updated telemedicine rules post-pandemic. Again, patients living in more rural areas may have a harder time finding an in-person provider to maintain a prescription.
If you don’t know where to look, contacting your local Planned Parenthood would be a good resource. Even if the branch doesn’t prescribe your particular hormone therapy, they may be able to refer you to another location that does. And as is true for other health care services, if you don’t have a primary care doctor, you can find and call your local health department in order to connect you to someone who can get your medication.
