CTeL Issues a Call to Action on Telehealth Prescription Flexibilities
As we approach the end of 2024, a ticking clock threatens the healthcare access of millions of Americans. Unless swift action is taken, the Drug Enforcement Administration’s (DEA) temporary telehealth flexibilities for prescribing controlled substances will expire at the end of this year. This change would have a profound and negative impact on patients who have come to rely on telemedicine for critical treatments, including medications for chronic pain, mental health, and substance use disorders.
In response to this impending crisis, the Center for Telehealth & e-Health Law (CTeL) and other healthcare organizations have called on Congress to act, sending a letter to the House Energy and Commerce Committee.
The message is clear: without legislative intervention, millions of patients could lose access to essential medications.
A Lifeline for Millions During the Pandemic
During the COVID-19 pandemic, the DEA allowed controlled substances to be prescribed via telemedicine without requiring an initial in-person visit. This temporary waiver played a critical role in ensuring continuity of care during a time when in-person visits were not feasible or safe for many.
By 2022, telehealth usage had soared by 38 times compared to pre-pandemic levels, according to a McKinsey report. A significant portion of this increase included the prescription of controlled substances, particularly for patients in rural and underserved areas. For example:
23.6 million Americans live in Health Professional Shortage Areas (HPSAs), regions that lack sufficient healthcare providers. Telehealth bridged this gap by enabling patients in these areas to receive timely care.
In 2021, 34% of telehealth visits involved mental health or substance use disorder treatment, highlighting the critical role that remote care plays in addressing these conditions.
The removal of the telehealth flexibilities will disproportionately affect vulnerable populations, such as cancer patients, those managing chronic pain, and individuals with mental health or substance use disorders. These patients could face delays in care or be forced to travel long distances, compounding the physical and financial burdens they already endure.
The Stakes: What Happens If These Flexibilities Expire?
If the DEA’s temporary waiver expires, healthcare providers will once again be required to see patients in person before prescribing controlled substances. This will create significant obstacles for millions of people, particularly those living in rural areas where access to healthcare is already limited.
For example:
Studies have shown that 53 million Americans live in rural areas, with many relying on telehealth as their primary means of accessing healthcare. The return of in-person requirements would leave many without necessary treatment options.
Delayed treatment can have life-threatening consequences for individuals managing substance use disorders, chronic pain, or mental health issues. A report from the American Medical Association (AMA) noted that the death rate from drug overdoses increased by 30% in 2020, underscoring the importance of maintaining consistent access to medication-assisted treatment (MAT) for substance use disorders.
Furthermore, the demand for mental health services surged during the pandemic, with 40% of U.S. adults reporting symptoms of anxiety or depression in 2021. Telehealth provided a critical avenue for addressing this surge, yet removing access to telemedicine-prescribed controlled substances would place additional strain on an already overburdened healthcare system.
The Call for Congressional Action
CTeL’s letter to the House Energy and Commerce Committee emphasizes the urgency of codifying the telehealth flexibilities into law. The DEA has repeatedly failed to finalize a telemedicine special registration rule that would allow for controlled substances to be prescribed without an in-person visit. With time running out, Congress is being urged to step in and include provisions from the H.R. 5163 - TREATS Act in any upcoming funding or health policy package. This act would safeguard the ability of healthcare providers to prescribe controlled substances via telehealth, ensuring that millions of Americans maintain access to the care they need.
“We urge Congress to act before it’s too late. The expiration of these waivers will create unnecessary barriers to care for millions of patients, particularly those with limited access to healthcare due to location, financial hardship, or health-related challenges. Delaying treatment by requiring an in-person visit is not only clinically unjustified but also places undue strain on both patients and healthcare providers”
Key points from CTeL’s letter include:
No clinical justification exists for requiring an in-person visit to prescribe controlled substances. The current telehealth model has been effective in delivering safe, timely care, with no significant increase in adverse outcomes.
Vulnerable populations, including those with cancer, chronic pain, mental health conditions, and substance use disorders, will be disproportionately affected by the expiration of these waivers. Many of these patients face geographic or financial barriers that make in-person visits challenging or impossible.
The waiver expiration would create an undue burden on healthcare providers, leading to increased administrative costs and longer wait times for patients.
What’s Next?
With only a few months remaining before the DEA’s temporary telehealth flexibilities expire, the clock is ticking. The stakes are incredibly high: millions of patients depend on the continuation of these policies for access to life-saving medications.
CTeL is calling on Congress, healthcare providers, and advocates to push for immediate action. Telehealth has proven to be a vital tool in delivering equitable and timely healthcare, and its benefits must not be rolled back. As the end-of-year deadline approaches, the need to codify these flexibilities into law has never been more urgent.
For more information and to read the full letter to Congress, visit CTeL’s website.
McKinsey & Company. (2021). Telehealth: A quarter-trillion-dollar post-COVID-19 reality? Retrieved from McKinsey.
Health Resources and Services Administration. (2021). Health Professional Shortage Areas (HPSA) Statistics. Retrieved from HRSA.
American Psychiatric Association. (2021). Telehealth Use in Mental Health Care During COVID-19. Retrieved from APA.
National Institute on Drug Abuse. (2022). Overdose Death Rates. Retrieved from NIDA.
American Medical Association. (2023). The evolving overdose epidemic: Trends and actions to save lives [PDF]. https://www.ama-assn.org/system/files/ama-overdose-epidemic-report.pdf