New DEA Rule for Telemedical Prescription of Controlled Substances
The United States Drug Enforcement Administration (DEA) recently announced the upcoming end of its temporary policy allowing easier access to telemedicine prescriptions for controlled substances during the COVID Public Health Emergency. This decision has significant implications for medical practitioners and individuals seeking ketamine treatment via telemedicine. In this article, we will break down the key points and what they mean for people interested in or already receiving ketamine treatment via telemedicine.
Reason for DEA's Decision and the Ryan Haight Act
The Ryan Haight Act is a law that regulates the prescribing of controlled substances online. It requires practitioners to conduct an in-person medical evaluation before prescribing these substances via telemedicine. The law was created to prevent tragedies like the overdose of Ryan Haight, a teenager who obtained drugs illegally online1. The law is still in effect, but the DEA has temporarily allowed telemedicine prescriptions during the COVID pandemic Public Health Emergency. However, this policy is ending soon, and the DEA has proposed a new rule to limit telemedicine prescriptions for controlled substances.
What is Ketamine?
Ketamine is a controlled substance that is commonly used as an anesthetic in medical settings. However, it has gained popularity in recent years as a treatment for depression and other mental health conditions. Ketamine treatments are typically administered through intravenous infusion or nasal spray, and they have been shown to provide rapid relief for people who have not responded to other treatments. In fact, ketamine has been called the biggest breakthrough in depression treatment in decades.
Notably, ketamine is a schedule III non-narcotic drug, which means the proposed rule allows for telemedicine prescription of ketamine under certain circumstances described below.
What is Telemedicine?
Telemedicine is the practice of delivering healthcare services through remote communication technologies, such as videoconferencing and telephone. This approach has become increasingly popular during the COVID-19 pandemic, as it allows people to receive medical care without leaving their homes. Telemedicine can be used for a variety of healthcare services, including mental health services like ketamine treatment.
The New DEA Proposed Rule
During the Public Health Emergency until now, telemedicine practitioners could prescribe controlled substances without a prior in-person medical examination. The new DEA proposed rule would change that by only allowing telemedicine practitioners to prescribe and dispense controlled substances, including ketamine, to their patients without an in-person medical examination only under certain circumstances. This change is significant because it could make accessing ketamine treatment more complicated for many people.
We are currently in a 30-day period for public comment about this proposed rule, and the DEA is expected to finalize this rule soon afterward. There will be a 180-day grace period by the end of which all clinics need to have established processes to fulfill the new regulations.
What Does This Mean for People Interested in Ketamine Treatment?
For those interested in or currently receiving ketamine treatment via telemedicine, the DEA's decision means that practitioners must conduct an in-person medical evaluation before prescribing ketamine, unless an exception applies2. Practitioners must also follow all state and federal laws and best practices when prescribing and monitoring the use of controlled substances.
The good news, however, is that the new rule still allows for more access than the prior regulation (Ryan Haight Act, which limited people from any controlled substance prescription without an in-person exam). Instead of having to travel to a physical location for an in-person medical examination, people can receive treatment from the comfort of their own home. This is particularly important for people who live in rural or remote areas where access to healthcare services may be limited. Additionally, telemedicine can help to reduce the spread of infectious diseases like COVID-19 by allowing people to receive medical care without leaving their homes.
What are the Exceptions for an In-person Medical Evaluation?
For schedule III, IV, and V non-narcotic controlled substances, including ketamine, a telemedicine practitioner may prescribe a 30-day maximum supply of the medication without conducting an in-person physical exam. The practitioner must check an official record of controlled medication prescriptions, called a Prescription Drug Monitoring Program (PDMP) to ensure the patient is not receiving the controlled substance from any other prescriber ahead of time.
To then continue prescription of the controlled substance, the practitioner must either conduct an in-person exam of the patient themselves or get a properly documented referral from another practitioner who has conducted an in-person exam of the patient.
What to Do if You Are Interested in Ketamine Treatment via Telemedicine
If you are interested in ketamine treatment via telemedicine, it is important to consult with a licensed medical practitioner who follows all state and federal laws and best practices for prescribing and monitoring the use of controlled substances3. Patients should ensure that the practitioner conducts an in-person medical evaluation, or that an exception like ones described above applies, before prescribing ketamine via telemedicine.
It is important to note that the rule is still in the proposed stage, and it could change before it is finalized. It is also important to make sure that the telemedicine practitioner is authorized to prescribe controlled substances in your state and that they are following all applicable laws and regulations. Patients should also be aware that not all insurance plans cover telemedicine services, or ketamine therapy, so they should check with their insurance provider or otherwise understand their out-of-pocket costs before starting treatment.
Where can I read more?
The DEA has provided easy-to-understand summaries for the public4.
Additional resources for patients can be found here:
- Is My Prescription a Controlled Medication? Controlled-Non Controlled List (dea.gov)
- Can My Medication be Prescribed through Telemedicine? Controlled Substance Guidance (dea.gov)
Additional resources for practitioners can be found here:
- Proposed Rules Summary Telemedicine Rules Summary.pdf (dea.gov)
- Proposed Rules Highlights for Medical Practitioners Telehealth Practitioner Narrative.pdf (dea.gov)
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- Ryan Haight Online Pharmacy Consumer Protection Act of 2008, 21 U.S.C. §§ 802, 829, 841(a), 842(a)(1)(A), 1301, 1302, 1306, 1307, 1311, 1312, 1319, 1341 (2008). https://www.congress.gov/110/plaws/publ425/PLAW-110publ425.pdf
- United States Drug Enforcement Administration. (2023). Telemedicine prescribing of controlled substances when the practitioner and the patient have not had a prior in-person medical evaluation. Retrieved from https://www.dea.gov/sites/default/files/2023-02/Telemedicine (DEA407).pdf
- American Society of Ketamine Physicians. (n.d.). Ketamine Treatment FAQ. Retrieved from https://www.askp.org/faq/
- Drug Enforcement Administration. (2023, February 24). DEA Announces Proposed Rules for Permanent Telemedicine Flexibilities. Retrieved from https://www.dea.gov/press-releases/2023/02/24/dea-announces-proposed-rules-permanent-telemedicine-flexibilities