Can Online Doctors Prescribe Controlled Substances

In an effort to combat the spreading coronavirus and COVID-19 pandemic, the U.S. government has taken unprecedented steps to keep Americans safe and healthy. The Centers for Disease Control and Prevention (CDC) issued guidelines for social distancing and self-isolation, and President Joe Biden signed executive orders that temporarily closed all nonessential businesses. In addition, the federal agency announced Monday, February 4, 2020, that it would be calling off most travel between states as well as within state borders except for emergencies or when necessary for employment purposes.
Now, there’s another major development to add to the list — healthcare providers can legally prescribe controlled substances via online prescription services.
On Tuesday, Feb. 5, the DEA released a statement clarifying its previous stance regarding telemedicine prescriptions. Previously, patients who wanted to receive a controlled substance from their doctor remotely had to have been prescribed the drug directly by that physician before they could obtain it through pharmacies, but this was not always possible because some physicians didn’t want to risk violating laws prohibiting them from prescribing controlled substances without seeing the patient in person first.
According to a report from CNBC, the change is designed to help healthcare workers provide care during the ongoing pandemic while also protecting the country from potential abuse of these powerful drugs. The rule change will go into effect on March 19, meaning doctors can now write prescriptions for controlled substances over video chats with patients.
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“The DEA recognizes the increased need for health care providers to address mental health conditions such as depression and anxiety,” DEA Administrator Uttam Dhillon said in a press release announcing the change. “We know that many people dealing with these conditions prefer to see a provider in person rather than relying solely upon medications they may already take.”
This move follows a recent trend of allowing doctors to treat patients at home via telemedicine, especially since the coronavirus crisis began. For example, earlier this month, the American Medical Association voted to allow physicians to provide virtual medical consultations to patients who live outside of their local areas. As recently as last year, more than 20 percent of primary care physicians were offering their services over telephone lines, according to research conducted by STAT News.
As for why the DEA decided to make this specific change, the agency explained that it’s trying to comply with a law passed in 2014 which allows physicians to prescribe certain controlled substances over the phone if they’re unable to meet patients in person. However, the fact that these prescriptions must still be written by someone physically present in the same building as the patient complicates things a bit.
“It’s important to note that the current rules prohibit pharmacists and pharmacy technicians from dispensing Schedule II and III controlled substances like benzodiazepines and opioids unless they are prescribers themselves,” the DEA said in its statement. “By adding a third party to the process, we believe the rules better reflect what happens in real world situations where pharmacists and pharmacy technicians typically fill prescriptions.”
While it might seem counterintuitive to allow physicians to prescribe controlled substances without actually meeting patients, one argument against this practice is that it increases the risks of overdose and misuse. According to Dr. Peter Rhee, assistant professor of medicine and director of clinical services for addiction medicine at Stanford University School of Medicine, patients sometimes get confused about whether they should follow up with their doctor after receiving a telemedicine appointment.
“People don’t understand how long [a doctor] will be gone,” he told us in an interview. “So they decide they’ll call back once [the doctor] gets out of his office.” But the problem then becomes that the patient doesn’t really know what kind of response they should expect, so they end up panicking if they don’t hear back right away.
Rhee recommends that patients who regularly use prescription painkillers consult their doctors face-to-face whenever possible, even if they’re only going to pick up a refill instead of a full new script. If you absolutely cannot see your doctor in person, however, you may want to avoid taking any controlled substances altogether until you’ve got a plan in place. Otherwise, you run the risk of accidentally doubling down on your habit.
“I think the best thing is to set up an appointments system where you can text somebody or email somebody,” Rhee says. “You’d tell them exactly what you want. And then say ‘this is my medication,’ and give them your information.”
If you ever feel unsafe taking a controlled substance, contact 911 immediately. While overdoses happen frequently among individuals who use illicit substances, those who use prescription meds are also susceptible to getting sick. It’s often difficult for doctors to tell which symptoms are caused by a physical illness versus a drug interaction, and it can be hard for patients to recognize warning signs of trouble until it’s too late.
For instance, opiate users are particularly prone to developing pneumonia, which is known to cause respiratory distress. Other side effects include constipation, nausea, drowsiness, dizziness, dry mouth, urinary retention, vomiting, sedation, hallucinations and sweating. Oxycontin, Percocet and Vicodin are just some of the popular prescription pills that contain oxycodone, hydrocodone and acetominophen respectively.

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