President Donald Trump on Thursday signaled his intention to break a logjam preventing doctors from treating opioid addiction through long-distance consults, a vital way to reach the hundreds of thousands of addicts living in rural and hard-to reach parts of the United States.
But the announcement caught the government agencies charged with making the changes off guard, and members of the industry that provides technology for the consults said more government action was needed to enable them.
The first item in Trump’s public health emergency declaration was to use telemedicine — video and phone-enabled communications with doctors, pharmacists and nurses — to remotely prescribe drugs for substance abuse and mental illness.
Under a 2008 law, doctors have been barred from prescribing anti-addiction medications to patients they haven’t seen in person first. The law created a barrier for addicts in rural, doctor-starved places that have been hit hardest by the crisis — and that voted for Trump in droves last November.
The Drug Enforcement Administration has the power to waive certain parts of the 2008 Ryan Haight Act, named for a teenager who overdosed in 2001 on Vicodin he bought online. The Justice Department agency was supposed to create guidelines for the DEA exceptions, but it hasn’t.
A Justice spokesman said the regulation is still under development, and wouldn’t speculate on when it would be finished. The DEA referred questions to the White House, which didn’t respond to queries. Trump didn’t mention telemedicine in his half-hour White House speech on the opioid order.
A single sentence from a fact sheet can’t override federal law, but it may be possible for the White House to instruct DEA not to enforce the Ryan Haight Act, said telemedicine attorney Nathaniel Lacktman of Foley & Lardner.
“We really need to see more from the White House on an actual rule or executive order to see what this would look like,” Lacktman said.
“This is going to put pressure on DEA to do what Congress asked them to do in 2008,” said Larry Cote, a former associate chief counsel at the agency who now works at the firm Quarles & Brady. But DEA has “been telling people for years they’re working on a regulation now, [so] the fact that they said it today means nothing to me.”
The potential of telemedicine to help fight opioid abuse in Trump country is large.
In West Virginia, where Trump noted that 1 in 5 babies is born with an opioid dependency because its mother is hooked on drugs, addiction patients often drive for hours to get therapy. The only doctors in the state equipped to treat addiction are in Morgantown, near the Pennsylvania border.
The clinic there has a waiting list of 500 patients, said Wanhong Zheng, a psychiatrist at the West Virginia University health system. Many of those patients might be treated effectively through telemedicine.
In rural western Maryland, another area of Appalachia hit hard by the opioid epidemic, doctors have taken matters into their own hands — using telemedicine to deliver lifesaving drugs, although what they are doing is technically illegal.
Eric Weintraub’s clinic sees more than 200 patients in Hagerstown through telemedicine from his office at the University of Maryland School of Medicine in Baltimore, 70 miles away. Two-thirds of Weintraub’s patients were still in his program after three months — only 6 percent tested positive for illicit drug use.
The lead author of the 2008 law said Thursday that it might be a good idea to change it.
“If the Ryan Haight Act needs to be updated, then let’s update it,” said former Rep. Mary Bono, who since leaving Congress has fought drug addiction by helping lead coalitions at the consulting firm Faegre Baker Daniels. “The issue back then is very different from what the issue has become.”
Ten years ago, Congress was cracking down on rogue internet pharmacies selling painkillers online. Today, street drugs like heroin and synthetic fentanyl pose the deadliest risks.
Telemedicine wasn’t an issue in 2008, and expanding it is “absolutely a good idea provided it’s done right,” she said.
The American Telemedicine Association’s president, California psychiatrist Peter Yellowlees, said he hoped the renewable 90-day declaration would become permanent. Hundreds of psychiatrists and addiction medicine physicians could be available to treat patients remotely, he said.
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