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Changes could be coming for telehealth

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Posted at 2:53 PM, Apr 11, 2023

TULSA, Okla. — In so many ways, COVID-19 forced people into the future. Many changes that occurred through the pandemic are now part of daily life. For those who don't have immediate access to a doctor, one big change is seeing the doctor without leaving their home.

“When I think about the rural population that has gotten access to addiction medicine, care, for the first time ever, I see my family members," said Dr. Kelly Dunn, executive director of clinical treatment at Oklahoma State University. "Personally, I think I almost cried.”

She’s describing her reaction to a proposed rule from the Drug Enforcement Administration. It will change how those who live far – and many who don’t – receive treatment for addiction.

“Telemedicine is a way to help people really access care early before it gets as bad as it can, before they lose everything, much less their life,” Dunn said.

The headline came in late February: “DEA Announces … Permanent Telemedicine Flexibilities.” It keeps most of the telehealth options that would have expired in May along with the federal COVID-19 public health emergency. What it doesn’t keep is the ability for many patients to use telehealth to receive certain controlled medications … including Buprenorphine.

“One of the major medications for opioid disorder is a controlled substance. And so, these regulations will prevent us from prescribing that via telehealth,” Dunn said.

The rule expands what was offered before the pandemic. But, Dunn says it ignores so much of what was learned during it. In 2021, America saw a record 106,000 deaths from drug overdose— 80,000 of those were from opioids. But a study by the National Institutes of Health found telehealth services related to opioid use led to improved retention of medicine and lower chances of overdose.

“The opioid epidemic didn't really need telehealth to come about. And so, it wasn't telehealth that drove that. But right now, it's telehealth that's driving a lot of the solution to that,” Dunn said.

In the 30 days available for public comment, more than 23,000 Americans wrote in. A Physicians Assistant from Tulsawrote her “patients many times have state insurance, limited transportation.” Without telehealth, she said, “I am afraid many will return to using opioids.” That P.A. is Alina Messick. She works with Dr. Dunn.

“They may not have vehicles. There's not a bus service that they can take. Coming from a large city, this was very eyeopening to me,” Messick said.

On May 11, the new rule will go into effect. The D.E.A. wouldn’t speak with us beyond their press release, in which they said the rules will “prevent the online overprescribing of controlled medications.”

Dunn and Messick say their program will adjust as best they can for their patients who live near and those who live far.

“I know where they’re coming from. Unfortunately, I don’t know if they really understand how health care is delivered in this country,” Dunn said.