WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA) expressed concern with repeated delays by the Drug Enforcement Administration (DEA) that are preventing providers from being able to properly treat their patients via telehealth. In a letter, Sen. Warner urged the DEA Acting Administrator to finalize a long-delayed rule that will ensure providers can successfully use telehealth to treat individuals with substance use disorders.

“Providers across the country have been frustrated in their inability to provide adequate care as they wait for Congressionally-mandated guidance from your agency to clarify the process whereby health care professionals can legally use telehealth to better treat patients suffering from substance use disorder,” wrote Sen. Warner. “The DEA’s failure to promulgate the rule has meant that – despite Congress’ best efforts – many patients suffering from substance use disorders remain unable to access treatment via telehealth. These patients cannot afford to wait and we are concerned the DEA is standing in the way of treatment for individuals that cannot access a provider in person – particularly those in rural and underserved areas.”

“The opioid and addiction epidemic has devastated communities nationwide, with a particularly devastating impact on rural and medically underserved areas,” he continued. “Expanding telehealth services to individuals suffering from substance use disorder can bridge the distance between patients and care and ensure increased access to services they need.”

In order to crack down on the online proliferation of dangerous controlled substances online, the Ryan Haight Act of 2008 prohibited the delivery, distribution, or dispensing of a controlled substance by means of the internet without a prior in-person exam. However, this prevented providers from properly using telehealth to treat individuals – particularly those in rural communities who rely on this service to obtain timely access to health care.

Sen. Warner helped draft and pass the Senate’s comprehensive substance abuse treatment bill, which included a provision directing the Department of Justice, in consultation with the Department of Health and Human Services, to create a process for exempting certain health care providers for the purpose of providing telehealth services for substance use disorder. In addition – that legislation included four other provisions led by Sen. Warner that use telehealth to expand access to treatment for individuals suffering from substance use disorder. The bipartisan legislation was signed into law in 2018; however, the Attorney General failed to finalize a rule by the October 2019 deadline. For provisions of this legislation to be most effective, the DEA must complete its rulemaking process.

In the letter to Acting Administrator Uttam Dhillon, Sen. Warner emphasized the wide disparity in opioid deaths between urban communities and rural communities, which have a 45 percent higher rate of deaths by opioids. Sen. Warner also requested that the DEA provide an explanation if it does not intend to promulgate rulemaking on this issue in a timely manner.

A copy of the letter can be found here and below.

Mr. Uttam Dhillon

Acting Administrator

Drug Enforcement Administration (DEA)

U.S. Department of Justice

800 K Street NW Suite 500

Washington, D.C. 20001

Acting Administrator Dhillon,

I am writing regarding the Drug Enforcement Agency’s (DEA) implementation of critical provisions in the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (Ryan Haight Act) (Public Law 91-513) and the recently passed SUPPORT for Patients and Communities Act (SUPPORT Act) (Public Law 115-271) that ensure individuals with substance use disorders can successfully access medical treatment via telehealth.

As you likely know – the Ryan Haight Act prohibits the delivery, distribution, or dispensing of a controlled substance online without first conducting an in-person exam. The intent of this law is to prevent illegitimate entities from selling dangerous controlled substances online while maintaining the ability for legitimate healthcare providers to treat patients in need.

The Ryan Haight Act also directed the DEA to promulgate rules exempting certain health care professionals from this requirement with the goal of ensuring patients have access to care via telehealth. However, in the 10 years since passage, the DEA has not promulgated rules to this effect. Congress further expressed its intent in passing the SUPPORT Act in 2018, which allows Medicare-eligible individuals suffering from substance use disorder to be diagnosed and treated via telehealth. The SUPPORT Act – similar to the Ryan Haight Act – mandated rulemaking by October 2019. Another deadline that has been missed.

Providers across the country have been frustrated in their inability to provide adequate care as they wait for Congressionally-mandated guidance from your agency to clarify the process whereby health care professionals can legally use telehealth to better treat patients suffering from substance use disorder. The DEA’s failure to promulgate the rule has meant that – despite Congress’ best efforts – many patients suffering from substance use disorders remain unable to access treatment via telehealth. These patients cannot afford to wait and we are concerned the DEA is standing in the way of treatment for individuals that cannot access a provider in person – particularly those in rural and underserved areas.

The opioid and addiction epidemic has devastated communities nationwide, with a particularly devastating impact on rural and medically underserved areas. According to the Centers for Disease Control and Prevention (CDC), there were more than 70,000 overdose deaths in 2017 – a 9.6 percent increase from 2016.   Furthermore, the CDC cites opioid deaths as 45% higher in rural areas, compared to urban communities. 

Expanding telehealth services to individuals suffering from substance use disorder can bridge the distance between patients and care and ensure increased access to services they need.

As detailed above, Congress passed the SUPPORT Act in 2018 and instructed the Attorney General – in consultation with the Department of Health and Human Services (HHS) – to promulgate rules on health care professional exemptions for prescribing controlled substances via telemedicine. This rule will ensure providers can successfully use telehealth to treat patients with substance use disorders. HHS has previously published suggestions on the potential uses of telehealth to diagnose and treat substance use disorder, but until the DEA takes action, providers will continue to face significant barriers in using telehealth to treat patients with substance use disorders. 

I strongly urge the DEA to promulgate rulemaking on this issue as soon as possible so that patients suffering from substance use disorders can receive the care they need. Furthermore, I ask that if you do not intend to promulgate this rule in a timely manner you respond in writing with an explanation of your decision. Thank you for your consideration of this request and I look forward to your response.

Sincerely,

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