21/02/2024
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At Citizens Health Hospital in Colby, Kansas, pandemic-driven rule changes allow doctors to prescribe chronic pain and mental health medications on virtual appointments.

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This has given hundreds of patients in Northwest Kansas access to life-changing drugs.

Everyone struggles with access to mental health care, said Jenny Niblock, a nurse at the medical center. Rural Kansas struggles even worse.

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Before the pandemic, the only way to get a prescription for a federally regulated drug was through an in-person doctor visit.

When the federal government declared the COVID-19 pandemic a national public health emergency, it allowed doctors to prescribe drugs remotely to reduce in-person appointments and avoid further spread of the virus.

The resulting telehealth appointments meant a patient could get tightly controlled medications without leaving their home.

Patients liked the change. So have doctors, though fears remain that telehealth could give addicts greater access to prescription drugs.

But it brought with it some bad actor companies and suppliers that fell through federal investigation out of suspicion they prescribed drugs without thoroughly diagnosing and monitoring their patients.

Now the US Drug Enforcement Administration is trying to strike a balance between increasingly popular remote care and efforts to curb prescription drug abuse.

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Proposed rules the Biden administration released in February suggested reinstating some restrictions on telemedicine prescriptions when the public health emergency ended on May 11.

Pushback from medical groups including the American Academy of Physicians and the American Hospital Association it resulted in a six-month extension that allows providers to continue prescribing drugs without an in-person visit. But it still leaves healthcare professionals unsure how to prepare themselves and their patients for the long term.

For drugs like Vicodin, OxyContin and Adderall, the proposed regulations would require in-person visits before prescribing those drugs. Telehealth appointments would then be canceled for refills.

Citizens Health is a critical access hospital and the only way Citizens Health can offer some specialty care services, including psychiatry, is through telehealth. The only psychiatrist does not work in the hospital.

If that psychiatrist can no longer prescribe medicine because there is never an opportunity to see that patient face-to-face, Niblock said, we will lose access to mental health services.

That means people would have to wait months for an appointment or drive several hours to a larger hospital if regulations returned and drug prescriptions required in-person appointments.

What we always see is people just don’t walk away, he said. So they have no cure.

Other drugs, including buprenorphine, used to treat opioid addiction by curbing cravings, would be available for one-month prescriptions versus telemedicine. But they would require an in-person appointment for a refill.

Kansas ranked second in the nation for largest percentage increase of overdoses in 2021.

Substance use disorder treatment is another field that’s short on providers, said Shane Hudson, president and CEO of CKF Addiction Treatment in Salina, Kansas. He said some people would find it difficult to go to a clinic to refill prescriptions after the first month.

It’s easy to say for some people that, like, well, that’s no problem, Hudson said.

But he said living in remote areas and on limited incomes may make some forms of treatment out of reach without telehealth.

CKF helps Kansans across the state through a network of medical providers who use telehealth to help connect people to care. This includes the drug-assisted treatment that CKF provides to approximately 200 patients.

Hudson said she understands why there might be some hesitation about the flexibility to prescribe all controlled substances through virtual appointments.

That’s a valid fear, Hudson said. But that doesn’t speak for all of us.

Easing rules during the pandemic has attracted some mental health startups. Cerebral Medical Group and Done Global Inc. both took to social media offering quick attention-deficit/hyperactivity disorder (ADHD) diagnoses and prescriptions for Adderall and Xanax. Both companies are under federal investigation for alleged over-prescription.

It really stems from the fact that right now, while I think it’s a very legitimate concern, that we need to limit inappropriate prescribing, we don’t see evidence that this is a big deal right now, said Dr. Ateev Mehrotra, professor of health policy and medicine at Harvard Medical School.

Mehrotra said the DEA’s proposed restrictions take on the more traditional criminal justice stance with controlled substance prescriptions. While oversight is needed for bad actors, she said, there is also the public health approach to removing barriers to care.

We also need to keep access for as many people as possible, Mehrotra said.

Hudson said the rules can curb the abuse of telehealth prescriptions. But she said the general policies hurt addiction treatment centers like her trying to reach as many patients as possible.

A 30-day comment period on the Biden administration’s proposed rules garnered more than 38,000 responses.

This led to federal governments recent announcement which will extend remote prescribing flexibility for another six months. Patients who have an established telehealth relationship with a provider by November 11, 2023, will have a one-year grace period before having to follow any new telehealth regulations.

The delay offers supplier Jenny Niblock in northwest Kansas a moment of temporary relief.

In rural Kansas, we were always like, like, we’ve lived another day, Niblock said. So we bought another six months.

Samantha Horton reports on health for the Kansas News Service. You can follow her on Twitter @SamHorton5.

The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.

Kansas News Service stories and photos are free to be republished by the media with proper attribution and a link to ksnewsservice.org.


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