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      Make a Bold Style Statement With These Wide-Leg Pants

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      Power Your Winter Workouts With The Best Zip Hoodies for Men

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      The Ultimate Watch Buying Guide

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      Outdoor Enthusiasts, Take Note: These Watches Are as Tough as You

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      Our 7 Favorite Field Jackets for Tackling Fall Weather

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        The Best Flour Alternatives That Work in Any Recipe

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        Cheese Tortellini in Creamy Marinara

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        Unusual Products That Come From Animals and Their Uses

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          Science Says Teens Need More Sleep. So Why Is It So Hard to Start School Later?

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          Start Shopping: Enrollment Begins Nov. 1 for Most Obamacare Insurance Plans

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          Why Is Finding Covid Shots for Young Children Still So Hard?

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          For People With Sickle Cell Disease, ERs Can Mean Life-Threatening Waits

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          Mothers of Color Can’t See if Providers Have a History of Mistreatment. Why Not?

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          Social Security Overpayments Draw Scrutiny and Outrage From Members of Congress

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          Florida Gov. Ron DeSantis Injects Presidential Politics Into the Covid Vaccine Debate

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              Defense contractors spent $70 million lobbying ahead of annual defense budget bill

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              ByteDance sets new lobbying record amid scrutiny of TikTok’s China ties

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              Campaign Legal Center and OpenSecrets sue the FEC for delayed response to transparency rulemaking petition

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              Incumbent politicians enjoy record reelection in an aging Congress

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              Kentucky governor’s race on track for new fundraising record

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              Ante up: $8 million casino referendum in Virginia breaks state record

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              OpenSecrets Partners with Browser Extension Consciously to bring Political Giving Alerts to Online Shopping Experience

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              Primaries underway for America’s third-largest party with grassroots and self-funded candidates

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                  Essential Gifts for Every Beekeeper: From Novices to Experts

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                  Things To Consider Before Becoming a Landlord

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                  Mistakes To Avoid When Starting Your Online Store

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                    Essential Tips for Planning a Great Fashion Show

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                    Signs That Your Tuxedo Doesn’t Fit Right

                    Signs That Your Tuxedo Doesn’t Fit Right

                    Make a Bold Style Statement With These Wide-Leg Pants

                    Make a Bold Style Statement With These Wide-Leg Pants

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                    Power Your Winter Workouts With The Best Zip Hoodies for Men

                    The Ultimate Watch Buying Guide

                    The Ultimate Watch Buying Guide

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                    Outdoor Enthusiasts, Take Note: These Watches Are as Tough as You

                    Our 7 Favorite Field Jackets for Tackling Fall Weather

                    Our 7 Favorite Field Jackets for Tackling Fall Weather

                    The Best Leather Jackets for Guys – No Matter Your Budget

                    The Best Leather Jackets for Guys – No Matter Your Budget

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                      Energizing Foods and Drinks To Consume Before a Workout

                      Energizing Foods and Drinks To Consume Before a Workout

                      Classic Beer Styles You Should Know How to Brew

                      Classic Beer Styles You Should Know How to Brew

                      The Best Flour Alternatives That Work in Any Recipe

                      The Best Flour Alternatives That Work in Any Recipe

                      Cheese Tortellini in Creamy Marinara

                      Cheese Tortellini in Creamy Marinara

                      Unusual Products That Come From Animals and Their Uses

                      Unusual Products That Come From Animals and Their Uses

                      Tips for Creating a Homemade Wine Cellar

                      Tips for Creating a Homemade Wine Cellar

                      How the wine you choose can help you have an eco-friendly home

                      How the Wine You Choose Can Help You have an Eco-Friendly Home

                      Rum and Cola Holiday Ham

                      Special Centerpieces for Holiday Celebrations

                      ChefsGiving 2020

                      This Holiday Season, How about Cooking for a Cause?

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                        Another GOP Primary Debate … Another Night of Verbal Clashes

                        Another GOP Primary Debate … Another Night of Verbal Clashes

                        Science Says Teens Need More Sleep. So Why Is It So Hard to Start School Later?

                        Science Says Teens Need More Sleep. So Why Is It So Hard to Start School Later?

                        Start Shopping: Enrollment Begins Nov. 1 for Most Obamacare Insurance Plans

                        Start Shopping: Enrollment Begins Nov. 1 for Most Obamacare Insurance Plans

                        Why Is Finding Covid Shots for Young Children Still So Hard?

                        Why Is Finding Covid Shots for Young Children Still So Hard?

                        For People With Sickle Cell Disease, ERs Can Mean Life-Threatening Waits

                        For People With Sickle Cell Disease, ERs Can Mean Life-Threatening Waits

                        Mothers of Color Can’t See if Providers Have a History of Mistreatment. Why Not?

                        Mothers of Color Can’t See if Providers Have a History of Mistreatment. Why Not?

                        Social Security Overpayments Draw Scrutiny and Outrage From Members of Congress

                        Social Security Overpayments Draw Scrutiny and Outrage From Members of Congress

                        As Younger Children Increasingly Die by Suicide, Better Tracking and Prevention Is Sought

                        Florida Gov. Ron DeSantis Injects Presidential Politics Into the Covid Vaccine Debate

                        Florida Gov. Ron DeSantis Injects Presidential Politics Into the Covid Vaccine Debate

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                          What To Know Before Popping the Big Question

                          What To Know Before Popping the Big Question

                          The Benefits of Visiting a Multicultural City

                          The Benefits of Visiting a Multicultural City

                          A woman working remotely

                          Your Ultimate Guide to the Best Remote Work Destinations Worldwide

                          Common Dog Owner Mistakes and How To Avoid Them

                          Common Dog Owner Mistakes and How To Avoid Them

                          3 Reasons To Give an Antique or Vintage Engagement Ring

                          3 Reasons To Give an Antique or Vintage Engagement Ring

                          Tim Ferris

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                          Outdoor Luxuries To Add to Your Backyard

                          Outdoor Luxuries To Add to Your Backyard

                          Strategy and business planning ideas. Chess gold on the board.

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                          Huge Money Mistakes New Parents Fall For

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                            Defense contractors spent $70 million lobbying ahead of annual defense budget bill

                            ByteDance sets new lobbying record amid scrutiny of TikTok’s China ties

                            ByteDance sets new lobbying record amid scrutiny of TikTok’s China ties

                            Virginia campaigns set fundraising records

                            Virginia campaigns set fundraising records

                            Campaign Legal Center and OpenSecrets sue the FEC for delayed response to transparency rulemaking petition

                            Campaign Legal Center and OpenSecrets sue the FEC for delayed response to transparency rulemaking petition

                            Incumbent politicians enjoy record reelection in an aging Congress

                            Incumbent politicians enjoy record reelection in an aging Congress

                            Kentucky governor’s race on track for new fundraising record

                            Kentucky governor’s race on track for new fundraising record

                            Ante up: $8 million casino referendum in Virginia breaks state record

                            Ante up: $8 million casino referendum in Virginia breaks state record

                            OpenSecrets Partners with Browser Extension Consciously to bring Political Giving Alerts to Online Shopping Experience

                            OpenSecrets Partners with Browser Extension Consciously to bring Political Giving Alerts to Online Shopping Experience

                            Primaries underway for America’s third-largest party with grassroots and self-funded candidates

                            Primaries underway for America’s third-largest party with grassroots and self-funded candidates

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                              Transforming Urban Rooftops Into Sustainable Green Spaces

                              Transforming Urban Rooftops Into Sustainable Green Spaces

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                              How To Make Your Rental Property More Eco-Friendly

                              How To Make Your Rental Property More Eco-Friendly

                              Things To Consider Before Investing in Real Estate Overseas

                              Things To Consider Before Investing in Real Estate Overseas

                              Incredible Areas in Florida To Buy a Vacation Home

                              Incredible Areas in Florida To Buy a Vacation Home

                              Helpful Home Staging Tips for Virtual Tours

                              Helpful Home Staging Tips for Virtual Tours

                              Ways To Decorate and Design a Lake House

                              Ways To Decorate and Design a Lake House

                              Challenges To Managing a Rental Property

                              Challenges To Managing a Rental Property

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                              Behavioral Telehealth Loses Momentum Without a Regulatory Boost

                              by Staff Writer
                              February 1, 2023
                              in Health
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                              By Darius Tahir

                              [UPDATED on Jan. 11]

                              Controlled substances became a little less controlled during the pandemic. That benefited both patients (for their health) and telehealth startups (to make money).

                              Some potentially addictive medications — like buprenorphine and Adderall — are now far more available online to patients because of regulatory changes. Given the scarcity of qualified doctors to treat some of the behavioral health conditions associated with these drugs, like opioid use disorder or attention-deficit/hyperactivity disorder, doctors’ new ability to prescribe online or, in some cases, by telephone is a huge change. But easier access to the drugs has both upsides and downsides, since they’re often dispensed without accompanying therapy that improves the odds of a patient’s success.

                              Pre-pandemic, patients sometimes traveled several hours for addiction care, said Emily Behar, director of clinical operations for Ophelia, a New York startup serving people with opioid addictions. Or patients might be struggling with multiple jobs or a lack of child care. Such obstacles made sustaining care fraught.

                              “How do you reach those people?” she asked.

                              It’s a question preoccupying much of the behavioral health sector, complicated by the reality that most patients with opioid use disorder aren’t in treatment, said Dr. Neeraj Gandotra, chief medical officer of the Substance Abuse and Mental Health Services Administration.

                              Increased access to telehealth has started to provide an answer. Behar, the startup executive, says its patients can see expert providers at their convenience. Missed appointments are dropping, say many in the industry.

                              The startup has secured solid funding — nearly $68 million, according to Crunchbase, an industry database — but addiction specialists and other prescribers of controlled substances online are a mixed group. Some are nonprofits; others are large startups attracting scrutiny from the news media and law enforcement for allegedly sloppy prescription practices.

                              The influx of new providers is attributable to loosened requirements born of pandemic-era necessity. To help patients get access to care while maintaining physical distance, the Drug Enforcement Administration and SAMHSA waived restrictions on telehealth for controlled substances.

                              But whether those changes will endure is uncertain. The federal government is working piecemeal to codify new rules for prescribing controlled substances, in light of the health care system’s pandemic experience.

                              On Dec. 13, SAMHSA issued a proposal to codify telehealth regulations on opioid treatment programs — but that affects only part of the sector. Left unaddressed — at least until the DEA issues rules — is the process for individual providers to register to prescribe buprenorphine. The new rules “get us at least a little bit closer to where we need to go,” said Sunny Levine, a telehealth and behavioral health lawyer at the firm Foley & Lardner, headquartered in Milwaukee.

                              Congress also tweaked rules around buprenorphine, doing away with a long-standing policy to cap the number of patients each provider can prescribe to. Ultimately, however, the DEA is the main regulatory domino yet to fall for telehealth providers.

                              In addition, pharmacies are taking a more skeptical stance on telehealth prescriptions — especially from startups. Patients were getting accustomed to using telemedicine to fill and refill their prescriptions for medications for some controlled substances, like Adderall, primarily used to treat ADHD. A shortage of Adderall has affected access for some patients. Now, though, some pharmacies are refusing to fill those prescriptions.

                              Cheryl Anderson, one Pennsylvanian with ADHD, said she sought online options because of her demanding schedule.

                              “My husband is frequently out of town, so I don’t have someone to reliably watch the baby to go to an in-person appointment,” she said. It was tough, with three kids, to find the time. Telehealth helped for about half of 2022. Previously, the DEA and state governments imposed tough rules on obtaining controlled substances from online pharmacies.

                              But in September, after her doctor wrote a refill prescription, she got a phone call saying her local pharmacy wouldn’t dispense medications if the prescription came through telehealth. Other local pharmacies she called took the same position.

                              Those denials seem to reflect a broader cultural shift in attitudes. Whereas patients and politicians hailed telemedicine at the beginning of the pandemic — first for its safety but also for its increased convenience and potential to extend care to rural areas and neighborhoods without specialists — hints of skepticism are creeping in.

                              The telehealth boom attracted shady actors. “You had a lot of people who saw an opportunity to do things that were less than scrupulous,” particularly in the behavioral health market, said Michael Yang, a managing partner at the venture capitalist firm OMERS Ventures. Skeptical media coverage has proliferated of startups that, allegedly, shotgun prescriptions for mental health conditions without monitoring patients receiving those medications. “It’ll settle down.”

                              The startups pose quandaries for local pharmacists, said Matt Morrison, owner of Gibson’s Pharmacy in Dodge City, Kansas.

                              Pharmacists have multiple obligations related to prescriptions, he said: to make sure incoming prescriptions are from legitimate physicians and that they’re connected to an actual health condition before filling the order. The sense around the industry, Morrison said, is that prescriptions from startups are tricky. They might come from a distant provider, whom the pharmacist can’t contact easily.

                              Those qualms pose difficulties for addiction treatment. Persuading pharmacists to fill prescriptions is one of the biggest administrative tasks for Ophelia, Behar said. Still, the shift online has been helpful.

                              “Telehealth picks up the gaps,” said Josh Luftig, a founding member of CA Bridge, a program based in Oakland, California, that helps patients in emergency departments initiate treatment for substance misuse. The supply of care providers wasn’t enough to meet demand. “Across the board, there’s been a lack of access to treatment in the outpatient setting. Now all they need is a phone and to get to a pharmacy.”

                              Treatment is more efficient for patient and provider alike, providers say. “The majority of our patients prefer to have a telehealth experience,” he said. “The telehealth appointments are more efficient. It increases the capacity of each person involved.”

                              Well-established organizations also report success: Geisinger, a large mid-Atlantic health system, said 94% of participants in one maternity-focused program were compliant, spokesperson Emile Lee said.

                              Ophelia, which started up just before the pandemic, expected to treat patients both in-office and online. “We have an office in Philadelphia we’ve never used,” she said. Now the company labors every few months — in anticipation of the end of state and federal public health emergencies — to make sure that the end of the associated looser rules doesn’t lead to disruptions in care for their patients.

                              More clarity on the future of online treatment could result from permanent regulations from the DEA. What the agency’s rule — which would create a registration process for providers interested in prescribing controlled substances online — will say is “anyone’s guess,” said Elliot Vice, an executive specializing in telehealth with the trade group Faegre Drinker. That rule has been pending for years. “To see this still not move, it is puzzling.”

                              The agency, which declined to comment specifically for this article, pointed to previous statements praising increased access to medication-assisted treatment.

                              “There shouldn’t be any change in the rules for telehealth,” Luftig said. “It would be the most horrific thing in terms of access for our communities. It would be an unmitigated disaster.”

                              This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

                              KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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