The Covid public health emergency, which looks increasingly likely to end as soon as April, could curtail access to drugs used to treat substance use disorders and mental illnesses. Why? Pandemic waivers allowed people with substance use disorders and mental health conditions to obtain prescriptions via telehealth visits for controlled substances safeguarded by the Drug Enforcement Administration, which have traditionally required in-person doctor visits to get. Congress extended many telehealth rules spawned by the pandemic in the year-end funding bill but not DEA rules on virtual prescribing of controlled substances. Could the DEA act between now and April? Maybe. The Biden administration has said in its newly released policy agenda that it expects to issue a proposed rule this month to facilitate virtual prescribing of buprenorphine — a drug used to treat opioid use disorder — and a separate regulation permitting access to controlled substances by telemedicine. But the DEA has mulled virtual prescribing since Congress directed it to do so in a 2008 law and the agency has missed two congressional deadlines to set up a special registration process to allow for it. Shawn Ryan, chair of the American Society of Addiction Medicine's legislative advocacy committee, suggested that the eased regulations could be extended through the opioid crisis public health emergency, which has been in place since 2017. Tasked with preventing drug misuse, the DEA is concerned that some virtual prescribers abused pandemic waivers to overprescribe medicine. It’s reportedly investigating two firms, Cerebral and Done, for allegedly overprescribing controlled substances used to treat attention-deficit hyperactivity disorder. The DEA alleged last month that Truepill, which served as the pharmacy for virtual mental health care firm Cerebral, doled out controlled substances without a legitimate medical purpose. According to The Wall Street Journal, Truepill’s CEO said the firm is cooperating with the DEA and is “confident we will be able to demonstrate the absence of wrongdoing.” The agency declined to comment on its post-Covid emergency plans. What’s at stake? The need for effective treatment of substance use disorder and mental illness is immense. HHS’ Substance Abuse and Mental Health Services Administration said last week that its 2021 survey found that more than 15 percent of the population, about 46 million people, had a substance use disorder, and about 1 in 4 adults had a mental illness. And while the number of people seeking mental health care is growing, SAMHSA said that nearly 94 percent of people with substance use disorder didn’t receive treatment in 2021. Gender-affirming care providers like Plume and FOLX also hope that expanded access to virtual controlled substance prescribing stays intact. Otherwise, testosterone access would become more limited. “Given the difficulty that many trans patients encounter finding safe, affirming care in their communities, that would present a significant hardship,” said Jerrica Kirkley, co-founder and chief medical officer of Plume.
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