Will Telehealth Opioid Prescriptions Continue After Pandemic?

A growing number of Americans with opioid use disorder have benefited from a rule change early in the pandemic that allowed them to access prescriptions of their controlled medications, via telehealth. The continuation of virtually prescribing controlled medications is telehealth's most controversial frontier, NPR reports. These medications, which are themselves opioids, are regulated heavily by the Drug Enforcement Administration. Normally, a patient must see their doctor regularly — in person — to get the medications. At the outset of the pandemic, the DEA and all 50 states temporarily suspended those safeguards, even allowing prescribing by out-of-state physicians, a practice normally prohibited by medical boards. In deciding the future of telehealth rules, policymakers are looking for data to figure out the lessons learned — what worked, what didn't — during this emergency period.

"We've now had 18 months to have telehealth expand dramatically; it would be a huge mistake to roll back that progress," said Sen. Mark Warner (D-VA). "If you cut off that ability to deliver those substances with appropriate protections, you're really cutting back on the path to recovery for a lot of folks." Yet of the estimated 1,000 telehealth bills pending before state and federal lawmakers, very few mention controlled medications. There is always a risk that some patients and doctors may try to abuse telehealth rules to divert drugs, says California addiction specialist Joseph DeSanto. Last year, DeSanto found more benefit than downside; during the pandemic, he was able to care for 20 patients living out of state. On the other hand, there are downsides to relying so heavily on virtual-only treatment, says Dr. Anna Lembke, a psychiatrist and professor of psychiatry at Stanford. "We've seen an increased number of patients who told us that they were doing fine — saying they were taking their buprenorphine — who then overdosed from fentanyl," she says. "In retrospect [we] wonder [if they]would have been caught if we had been getting regular urine [toxicology] screens, or had we been seeing them in person."