Clock is still ticking on virtual mental health prescribing

Congress acted last month to extend important telehealth flexibilities that will ensure millions of Americans and their providers will continue to have access to telehealth when the COVID-19 public health emergency is officially over. The importance of these policy extensions can’t be overstated. However, there is one remaining critical action item: prescribing for mental health and substance abuse treatment.

To ensure that prescribing controlled substances by telehealth can continue, the Drug Enforcement Agency (DEA) must publish a long-awaited registration process. This process is supposed to ensure patients get medications while guarding against inappropriate prescribing or rogue internet pharmacies.

The extent of the inaction by the DEA on this issue is staggering. It has been nearly 14 years since Congress required the agency to create a special registration to prescribe controlled substances through telemedicine. Not only did DEA blow through that deadline, but also a second deadline set by Congress in 2018. That’s essentially defying a congressional mandate — twice.

The White House declared enactment of the special registration process to be a “first-year Biden administration priority.”  We are now almost three years into the Biden presidency, yet this issue remains unaddressed, even while other mental health access policies advance.

In 2020, more than 80 organizations called on DEA to act based on significant national experience and evidence generated by the pandemic. These organizations pleaded that DEA “expedite and complete its efforts to implement a telemedicine special registration process enabling providers to safely prescribe controlled substances remotely.”

“Our experience during COVID-19 has demonstrated the value of increased access to telemedicine to enable all qualified providers, including Community Mental Health Centers and addiction treatment facilities, to prescribe Medication Assisted Treatment (MAT) to patients with Opioid Use Disorder (OUD),” they noted.

Still nothing.

Two years later, in 2022,  the number of stakeholder groups writing to DEA more than tripled to 300. The groups implored DEA to head off a pending cliff in the ability of providers to prescribe medication.

They asked, “what is the DEA’s plan to ensure that patients do not lose access to necessary treatment and medications” and “for patients who are currently in treatment with a provider that does not have a brick-and-mortar presence?”

“Today’s urgency on this issue need not exist,” they stressed.

Still nothing.

Approximately 50 members of Congress have supported legislation around ensuring the DEA Special Telemedicine Registration. Powerful members of the Senate, like Sen. Mark Warner (D-Va.), pushing publicly and privately.

What will it take? How many stakeholders pleading with them? How many members of Congress writing and passing legislation? How much evidence of the need for these vital medications to treat mental illness and substance abuse?

Action must be forthcoming soon or there will be a gap in care between the end of the COVID-19 pandemic’s public health emergency and the beginning of when providers can prescribe needed medications over telehealth.

Krista Drobac is the executive director of the Alliance for Connected Care, an organization dedicated to ensuring that all patients are able to realize the benefits of connected care.