Behavioral telehealth will lose momentum without regulatory strengthening

Controlled substances become a little less controlled during the pandemic. That benefits both patients (for their health) and telehealth startups (to make money).

Some potentially addictive drugs — like buprenorphine and Adderall — are now more available to patients online due to regulatory changes. Given the scarcity of qualified physicians to treat some of the behavioral health conditions associated with these drugs, such as opiate use disorder or attention deficit hyperactivity disorder, the new ability for physicians to Prescribing online or in some cases over the phone is a big change. But easier access to drugs has both positives and negatives, as they are often given without concomitant therapy, which improves patient success rates.

Emily Behar, clinical chief executive officer of Ophelia, a New York-based startup that specializes in serving opioid addicts, said that before the pandemic, patients sometimes had to travel several hours for post-treatment care. addiction. Or the patient may be struggling with multiple jobs or a lack of caregivers. Such obstacles make maintenance care difficult.

“How do you reach those people?” she asked.

It’s a question that preoccups much of the behavioral health field, complicated by reality, said Dr. Neeraj Gandotra, medical director of the Substance Abuse and Mental Health Services Administration. is that most patients with an opiate use disorder go untreated.

Increasing access to telehealth is already starting to give the answer. Behar, the startup’s chief executive, says its patients can see specialist providers at their convenience. Many in the industry say missed appointments are decreasing.

The startup has secured solid funding – almost $68 million, according to Crunchbase, an industry database — but addiction specialists and other controlled substance online prescribers are a mixed group. Some are nonprofits; others are large startups that attract scrutiny from the media and law enforcement for negligent prescribing practices.

The influx of new suppliers is due to the relaxed requirements due to the necessity of the pandemic period. To help patients access care while maintaining physical distancing, the Drug Enforcement Administration and SAMHSA have removed restrictions on telehealth for controlled substances.

But whether those changes will persist is uncertain. The federal government is working step-by-step to codify new rules for prescribing controlled substances, based on the health care system’s pandemic experience.

On December 13, SAMHSA released a proposal to codify telehealth regulations for opioid treatment programs — but that only affects part of the population. this field. Still unresolved – at least until the DEA issues the rules – is the process for individual providers to sign up to prescribe buprenorphine. Sunny Levine, a telehealth and behavioral health attorney at Foley & Lardner Company is based in DC.

Congress also tweaked the rules around buprenorphine, removing the longstanding policy of limiting the number of patients each provider can prescribe. Ultimately, however, the DEA is the primary regulatory domino that has yet to fall into the hands of telehealth providers.

Additionally, pharmacies are taking a more skeptical view of telehealth prescriptions — especially from startups. Patients are used to using telemedicine to fill and refill their prescriptions for certain controlled substances, like Adderall, which are primarily used to treat ADHD. One missing Adderall affected access for some patients. Now, however, some pharmacies are refusing to fill those prescriptions.

Cheryl Anderson, a Pennsylvanian with ADHD, said she searched for options online because of her packed schedule.

“My husband is often away from home so I don’t have a reliable babysitter to go to in person for appointments,” she says. It was difficult, with three kids, to find the time. Telehealth has been around for about half of 2022. In the past, the DEA and state governments have imposed strict regulations on purchasing controlled substances from online pharmacies.

But in September, after her doctor prescribed a refill, she got a phone call saying her local pharmacy wouldn’t dispense the medication if the prescription was sent via telehealth. The other local pharmacies she called had similar views.

Those rejections seem to reflect a broader cultural shift in attitudes. While patients and politicians hailed telemedicine at the start of the pandemic — first for its safety but also for its growing convenience and ability to extend care to rural areas and neighborhoods without a specialist — signs of skepticism are creeping in.

The telehealth boom has attracted shady actors. “There are a lot of people who have seen an opportunity to do less serious things,” said Michael Yang, a managing partner at venture capital firm OMERS Ventures. Because. Skepticism in the media has given rise to startups, which allegedly prescribe handgun powder for mental health conditions without monitoring patients using those drugs. “It will be fine.”

Matt Morrison, owner of Gibson’s Pharmacy in Dodge City, Kansas, said the startups pose a dilemma for local pharmacists.

Pharmacists have many obligations regarding prescriptions, he said: to make sure prescriptions come from legitimate doctors and that they are related to actual health conditions before filling orders. The feeling around the industry is that prescriptions from startups are complicated, says Morrison. They may come from a remote provider that the pharmacist cannot reach easily.

Those fears make it difficult to quit. Persuading pharmacists to fill prescriptions is one of Ophelia’s biggest administrative tasks, says Behar. However, the online change has been helpful.

“Remote health closes the gap,” said Josh Luftig, a founding member of CA Bridge, a program based in Oakland, California, that helps patients in emergency departments begin substance abuse treatment. The supply of care providers is not enough to meet the demand. “Overall, there is a lack of access to treatment in the outpatient setting. Now all they need is a phone and a pharmacy.”

Providers say the treatment is more effective for both the patient and the provider. “The majority of our patients prefer the telehealth experience,” he said. “Telemedicine appointments are more efficient. It increases the capacity of each person involved.”

Spokesperson Emile Lee said established organizations also report success: Geisinger, a large health system in the mid-Atlantic, says 94 percent of people participating in a pregnancy-focused program are compliant. .

Ophelia, which began just before the pandemic, is expected to treat patients both in-clinic and online. “We had an office in Philadelphia that we never used,” she said. Now, the company works every few months — in anticipation of the end of state and federal public health emergencies — to ensure that an end to the laxer rules involved do not result in a disruption in their patient care.

More clarity on the future of online treatment may result from longstanding regulations from the DEA. Elliot Vice, a telehealth executive with trade group Faegre Drinker, said the agency’s rule – would create an application process for providers interested in prescribing. controlled substances online – would say “anyone can guess”. That rule has been awaited for years. “Seeing this still not moving, it’s confusing.”

The agency, which declined to comment specifically for this article, pointed to earlier statements praising increased access to drug treatment.

“There shouldn’t be any changes in the rules for telehealth,” Luftig said. “That would be the most terrible thing about accessibility for our community. It would be an unmitigated disaster.”


News5s: Update the world's latest breaking news online of the day, breaking news, politics, society today, international mainstream news .Updated news 24/7: Entertainment, the World everyday world. Hot news, images, video clips that are updated quickly and reliably

Related Articles

Back to top button