It’s against state and federal law to use telehealth (remote medical services) to obtain buprenorphine for the first time; a medication used to treat opioid use disorder – often known by its brand names, Suboxone or Subutex. This law is known as the Ryan Haight Act, which is upheld by the DEA – and also prevents any controlled substances from being prescribed or purchased through online pharmacies. But changes are underway in Utah, where they’re seeking an exemption from this statute in order to treat more people suffering with opioid dependency.
Utah’s Lack of Treatment Professionals
The director of the Utah County Department of Drug and Alcohol Prevention and Treatment – Richard J. Nance – is pioneering a project as part of their State Targeted Response (STR) to the Opioid Crisis grant.
Nance is asking the DEA to allow the buprenorphine prescriber – doing the telemedicine consult – to provide buprenorphine prescriptions directly to the comprehensive counseling service providers. He tells Alcoholism & Drug Abuse Weekly, “The face-to-face first visit requirement is the high cost obstacle…His agency receives $180,000 a year of STR funding, “This is huge considering the clock is already ticking on the two years of federal opioid treatment funding.”
Nance’s department’s medical director, Elina Chernyak, is the only provider in the state certified to treat Utah’s current number of 275 patients with buprenorphine; which can mean up to two days travel, and cost inefficiencies, to treat a new patient. She states, “‘The problem with addiction is that the experts may know how to start people in treatment, but they are not always experts in how to maintain long-term recovery.” She feels it’s important for patients to be connected with good quality counselling; and, once stabilized, reduce the number of required visits.
Seeking Alternative Solutions
Nance is teaming up with a local federally qualified health center and a local state department of behavioral health authority for counseling and other comprehensive services.
He hopes this collaboration will generate some creative solutions to the specific problems faced by the people of Utah. Nance explains, “We have a lot of rural and frontier counties, some counties that don’t have a jail, where the entire population is less than 10,000 people.” Utah is seventh in the country in terms of per-capita overdoses. Nance attributes this startling number to prescription painkillers being a starting point for opioid dependency. He said, “In the four corners part of the state, there’s a lot of coal mining, so you have injuries related to that. And in northeastern Utah, we have the oil patch, so there’s the same thing – people working on drilling rigs, abusing methamphetamine, getting injured, having pain.”
However, under the Ryan Haight Act, buprenorphine can’t be prescribed without a face-to-face consultation; where a patient history is taken, and the current problem and treatment approach are discussed during the office visit. Nance and his associates new proposal is a comprehensive approach: to consult with the patient via a camera so the MAT provider can see the patient’s face; and the patient will be accompanied by a counselor, nurse, or mid-level prescriber. “But still, the DEA won’t let us do this,” said Nance.
Lawmakers Call for Change
Issues with the Ryan Haight Act have been recognized at National Council, where vice president for policy and advocacy, Rebecca Farley David, has called for amendments to be made to increase access to Suboxone treatment. She first noticed problems with this law – when some psychiatrists in Texas had difficulties prescribing controlled substances because their patients didn’t have a pharmacy. She stated that, “The Ryan Haight Act was enacted to crack down on illegal online pharmacies, and we supported it…But there are some exceptions, and telemedicine is one of those exceptions.”
The problem appears to be multi-faceted. First, the Ryan Haight Act requires telemedicine providers to register with the DEA. Second, mental health and chemical dependency professionals fall into a gray area because many aren’t already registered with the DEA. David explained, “There are issues with both the prescriber and the patient location – to prescribe any controlled substance you have to be registered with the DEA…But there may be an addiction treatment organization in which the facility itself is not registered with the DEA.”
In fact, the National Council is organizing a sign-on letter to the DEA about this issue. David believes the DEA needs to move more quickly, “We’re frustrated with the slow pace of the DEA…They’ve said a few times that rulemaking is imminent that would establish a special process for providers, but we’ve been hearing that for quite a while now.”
In the meantime, treatment options in Utah remain restricted due to their limited available resources. This is frightening when we’re in the middle of a deadly opioid epidemic. Especially in Utah – where they continue to experience overdose deaths that could be easily avoided with easier access to treatment.
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