{"id":596841,"date":"2023-01-12T10:49:27","date_gmt":"2023-01-12T16:49:27","guid":{"rendered":"https:\/\/news.sellorbuyhomefast.com\/index.php\/2023\/01\/12\/behavioral-telehealth-loses-momentum-without-a-regulatory-boost\/"},"modified":"2023-01-12T10:49:27","modified_gmt":"2023-01-12T16:49:27","slug":"behavioral-telehealth-loses-momentum-without-a-regulatory-boost","status":"publish","type":"post","link":"https:\/\/newsycanuse.com\/index.php\/2023\/01\/12\/behavioral-telehealth-loses-momentum-without-a-regulatory-boost\/","title":{"rendered":"Behavioral Telehealth Loses Momentum Without a Regulatory Boost"},"content":{"rendered":"
\n

[UPDATED on Jan. 11]<\/em><\/p>\n

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

Some potentially addictive medications \u2014 like buprenorphine and Adderall \u2014 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\u2019 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\u2019re often dispensed without accompanying therapy that improves the odds of a patient\u2019s success.<\/p>\n

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.<\/p>\n

\u201cHow do you reach those people?\u201d she asked.<\/p>\n

It\u2019s a question preoccupying much of the behavioral health sector, complicated by the reality that most patients with opioid use disorder aren\u2019t in treatment, said Dr. Neeraj Gandotra, chief medical officer of the Substance Abuse and Mental Health Services Administration.<\/p>\n

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.<\/p>\n

The startup has secured solid funding \u2014 nearly $68 million, according to Crunchbase<\/a>, an industry database \u2014 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.<\/p>\n

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.<\/p>\n

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\u2019s pandemic experience.<\/p>\n

On Dec. 13, SAMHSA issued a proposal to codify telehealth regulations on opioid treatment programs \u2014 but that affects only part of the sector. Left unaddressed \u2014 at least until the DEA issues rules \u2014 is the process for individual providers to register to prescribe buprenorphine. The new rules \u201cget us at least a little bit closer to where we need to go,\u201d said Sunny Levine, a telehealth and behavioral health lawyer at the firm Foley & Lardner<\/a>, headquartered in Milwaukee.<\/p>\n

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.<\/p>\n

In addition, pharmacies are taking a more skeptical stance on telehealth prescriptions \u2014 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<\/a> has affected access for some patients. Now, though, some pharmacies are refusing to fill those prescriptions.<\/p>\n

Cheryl Anderson, one Pennsylvanian with ADHD, said she sought online options because of her demanding schedule.<\/p>\n

\u201cMy husband is frequently out of town, so I don\u2019t have someone to reliably watch the baby to go to an in-person appointment,\u201d 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.<\/p>\n

But in September, after her doctor wrote a refill prescription, she got a phone call saying her local pharmacy wouldn\u2019t dispense medications if the prescription came through telehealth. Other local pharmacies she called took the same position.<\/p>\n

Those denials seem to reflect a broader cultural shift in attitudes. Whereas patients and politicians hailed telemedicine at the beginning of the pandemic \u2014 first for its safety but also for its increased convenience and potential to extend care to rural areas and neighborhoods without specialists \u2014 hints of skepticism are creeping in.<\/p>\n

The telehealth boom attracted shady actors. \u201cYou had a lot of people who saw an opportunity to do things that were less than scrupulous,\u201d 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. \u201cIt\u2019ll settle down.\u201d<\/p>\n

The startups pose quandaries for local pharmacists, said Matt Morrison, owner of Gibson\u2019s Pharmacy in Dodge City, Kansas.<\/p>\n

Pharmacists have multiple obligations related to prescriptions, he said: to make sure incoming prescriptions are from legitimate physicians and that they\u2019re 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\u2019t contact easily.<\/p>\n

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.<\/p>\n

\u201cTelehealth picks up the gaps,\u201d said Josh Luftig<\/a>, 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\u2019t enough to meet demand. \u201cAcross the board, there\u2019s been a lack of access to treatment in the outpatient setting. Now all they need is a phone and to get to a pharmacy.\u201d<\/p>\n

Treatment is more efficient for patient and provider alike, providers say. \u201cThe majority of our patients prefer to have a telehealth experience,\u201d he said. \u201cThe telehealth appointments are more efficient. It increases the capacity of each person involved.\u201d<\/p>\n

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.<\/p>\n

Ophelia, which started up just before the pandemic, expected to treat patients both in-office and online. \u201cWe have an office in Philadelphia we\u2019ve never used,\u201d she said. Now the company labors every few months \u2014 in anticipation of the end of state and federal public health emergencies \u2014 to make sure that the end of the associated looser rules doesn\u2019t lead to disruptions in care for their patients.<\/p>\n

More clarity on the future of online treatment could result from permanent regulations from the DEA. What the agency\u2019s rule \u2014 which would create a registration process for providers interested in prescribing controlled substances online \u2014 will say is \u201canyone\u2019s guess,\u201d said Elliot Vice, an executive specializing in telehealth with the trade group Faegre Drinker. That rule has been pending for years. \u201cTo see this still not move, it is puzzling.\u201d<\/p>\n

The agency, which declined to comment specifically for this article, pointed to previous statements praising increased access to medication-assisted treatment.<\/p>\n

\u201cThere shouldn\u2019t be any change in the rules for telehealth,\u201d Luftig said. \u201cIt would be the most horrific thing in terms of access for our communities. It would be an unmitigated disaster.\u201d<\/p>\n

[Correction:<\/em><\/strong> This article was updated at 10:30 a.m. ET on Jan. 11, 2023, to correct the location of Foley & Lardner\u2019s headquarters.]<\/em><\/p>\n<\/p><\/div>\n

Read More<\/a>
\n Darius Tahir<\/p>\n","protected":false},"excerpt":{"rendered":"

[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 \u2014 like buprenorphine and Adderall \u2014 are now far more available online to patients because of regulatory changes. Given the scarcity of qualified doctors<\/p>\n","protected":false},"author":1,"featured_media":596842,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[30394,34810],"tags":[],"class_list":{"0":"post-596841","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-behavioral","8":"category-telehealth"},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/posts\/596841","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/comments?post=596841"}],"version-history":[{"count":0,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/posts\/596841\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/media\/596842"}],"wp:attachment":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/media?parent=596841"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/categories?post=596841"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/tags?post=596841"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}