Proposed telemedicine rules could limit rural prescriptions

Superiorland seniors would be affected if changes go through

LANSING — Controlled medications like Adderall and opioids could no longer be prescribed via telemedicine, under a proposed rule by the U.S. Drug Enforcement Agency.

Critics say the use of telemedicine to prescribe the drugs, allowed during the COVID-19 pandemic, helps patients in rural areas and should continue.

Before the COVID-19 pandemic an in-person visit to a healthcare provider was required for a prescription for controlled substances.

“It could be one visit a month, or one visit every couple of months depending on the healthcare provider and the patient,” said Dr. Mark Hamed, the health department medical director of Huron, Lapeer, Sanilac, Tuscola, Alcona, Iosco, Ogemaw and Oscoda counties.

During the COVID-19 public health emergency that rule was eased and authorized providers could prescribe controlled substances without an in-person medical. They instead connected online over the internet with a smartphone, tablet or computer.

That was helpful, Hamed said.

“The only barrier was having a cellphone that worked and an internet signal that can provide for a video conference call,” he said.

The pandemic rule allowed these patients, who were afraid of getting COVID, as well as providers, who were afraid of getting COVID from patients, to have remote visits by phone or video conference, he said.

Patients, particularly in rural areas with few nearby doctors, could access the medications they needed.

With the public health emergency ending in May, the DEA has proposed reverting to the guidelines before COVID. It wants to require that at least one in-person visit to prescribe a controlled substance.

The proposed new rules are a hardship for people in rural communities without a nearby doctor, Hamed said. Sometimes the distance between the patient and the provider is 50 miles.

Denise Anthony, chair and professor in the department of health management and policy at the University of Michigan School of Public Health, said that the COVID-era guidelines gave needed access to care that people weren’t getting.

One argument for continuing the telemedicine guidelines, Anthony said, is the unequal distribution of mental health providers in the county.

“There are still limits to access to mental health care and access to health services,” she said.

Telemedicine is “literally a life-saver for people who otherwise wouldn’t get the help they needed,” Hamed said.

“(The proposed rules) are just putting up a barrier that doesn’t need to be there anymore. We saw it work well during the pandemic. Why go back and put the extra barrier that’s not needed?” he said.

One concern for relaxed telehealth guidelines is easy access to opioids and controlled substances, Anthony said.

“There were lots of disreputable providers out there who were prescribing when it was not appropriate,” she said.

“(The proposed guidelines) seem like a blunt instrument that the DEA is using to just say you have to have an in-person visit rather than telehealth access,” she said.

It’s more important to think about limiting the harm of unnecessary or inappropriate prescribing than the mode of access to care, she said.

COVID-era guidelines helped open up access to healthcare providers, said Alan Bolter, associate director of the Lansing-based Community Mental Health Association of Michigan.

The COVID-19 guidelines offered flexibility and met the demand of services through telehealth, Bolter said.

His organization has community mental health centers around Michigan.

Some of the centers have to rely on telehealth just to function, Bolter said.

“We are really hoping and advocating for the continuation of using (telehealth) and having the flexibility coming out of the pandemic,” he said.

The rule requiring an in-person visit with a health care provider was set to go into effect today, but the DEA has decided to allow the telehealth option to continue for an unspecified period of time.


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