Telehealth Opioids and Ryan Haight Act: Update

The Ryan Haight Act of 2008 was temporarily waived through the end of the COVID public health emergency (PHE) through the end of 2021 at the federal level, but after the PHE, it is slated to roll back into effect. It requires an in-person meeting before any practitioner can legally prescribe controlled substances via telehealth. To control the spreading virus, the United States Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued policies that made it possible for people suffering from opioid use disorder (OUD) to obtain medications in ways that would have been considered illegal before the pandemic. However, those freedoms will cease with the end of a public health emergency, and the DEA has yet to act on the appeal for special registration. The United States struggles with a prior public health emergency: a crisis of opioid and substance addiction during the COVID-19 pandemic. The highest number of overdose deaths ever was recorded in a span of 12-months ended in September 2020, which shows an increase of over 21% compared to the previous year.

In January 2020, Senator Mark Warner of Virginia originally pushed for the Trump administration to finalize the long-awaited rules to expand the use of telehealth services, but his attempt was unsuccessful. He is now again putting pressure on the federal government to implement a long-delayed bill that would enable healthcare providers to prescribe controlled substances through telehealth. The Virginia Democrat recently sent a letter to Attorney General Merrick Garland and Drug Enforcement Administration (DEA) Acting Administrator Chris Evans to create a registration process for providers who want to use telehealth services to prescribe medications used in substance abuse treatment.

“In practice, the DEA’s failure to address this issue means that a vast majority of health care providers that use telehealth to prescribe controlled substances to and otherwise treat their patients have been deterred in getting them the quality care they need,” Warner said in his letter. “These restrictions have been temporarily waived during the COVID-19 public health emergency, and I welcome that, but patients and providers need a more permanent and long-term solution to this long-delayed rulemaking.” Read the full text of the letter here.

What is The Ryan Haight Act?

Ryan Haight Act was named after an 18-year-old who died from an overdose of Vicodin prescribed to him by a telemedicine doctor without conducting an adequate medical evaluation in person. The prescription was then delivered to Haight’s door by an online pharmacy. Congress passed the Ryan Haight Online Pharmacy Consumer Protection Act in 2008 to change the Controlled Substances Act. The act significantly limited the conditions in which a controlled substance may be administered by telemedicine. According to the act, a telemedicine prescription for a controlled substance is only available if the treating physician has had a previous in-person assessment of the patient and the prescription was signed for a specific medical purpose.

How Has COVID-19 Impacted The Ryan Haight Act?

Following the declaration of a public health emergency by Health and Human Services (HHS), Former Acting DEA Administrator Timothy Shea announced that the DEA had adopted policies to prescribe controlled substances via telemedicine during the public health emergency (PHI). These policies allow prescription of controlled substances without first conducting an in-person examination if all of the following conditions were met:

• The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice;
• Telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system; and
• The practitioner is acting by applicable federal and state laws.

Proponents of permanently waiving the Ryan Haight Act (DEA – HHS.gov) are disappointed last December when the Drug Enforcement Agency was not required by the bipartisan COVID compromise package to permanently waive the act.

Final word

Telehealth is seen as a critical intervention by mental health and drug abuse treatment providers in addressing the nation’s substance abuse crisis, which had been growing before COVID-19 and has taken off since then. If the DEA changes its position and allows the changes brought about by the PHE to be made permanent, providers will be allowed to use interactive appointments and mHealth resources, such as ePrescribing, to increase access to care for patients who traditionally are reluctant to attend in-person meetings or cannot travel to in-person services to receive treatment.

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