Fake or Real: You Can Prescribe Controlled Substances through Telemedicine

March 3, 2020

Real…with some major caveats.

From groceries to workout classes, entrepreneurs in all industries are attempting to duplicate the “Amazon Effect.” The Amazon effect is the ongoing evolution and disruption of the retail market, both online and in physical outlets, resulting from increased e-commerce.  The digital marketplace is not only shifting the way people shop, but the future of medicine (See the 123s Of Telemedicine for additional back ground). While the ability to write telemedicine prescriptions offers an attractive opportunity to streamline the patient-doctor experience and reach patients with limited access to health care, prescribers need take caution. Filling internet prescriptions is a highly regulated area of law, especially in regard to controlled substances. Businesses dipping into telemed prescriptions needs to familiarize themselves with national and state legislation that affect this digital marketplace.

In many states, a telemed prescription cannot legally be filled without an initial in-person exam by the prescriber. Complicating this rule, the federal government passed the Ryan Haight Act (“Act”) in 2008. Many states look to this legislation for guidance in shaping laws surrounding internet prescriptions and the distribution of controlled substances. In short, the Act prohibits the distribution of controlled substances by means of the internet unless the ordering physician/prescriber has conducted at least one in-person exam and the prescription is issued for a valid medical reason. The Act also describes seven exceptions from the above requirements. The problem is that these ‘exceptions’ provide such a narrow definition of telemedicine that the Act actually inhibits legitimate telemedical prescribers trying to reach patients with otherwise limited access to health care.

While the Act was written to shut down internet pharmacies that were attempting to circumvent a physician’s exam and reduce the amount of illegal prescriptions for controlled substances, it has failed to account for how legitimate telemedicine businesses operate. Recently, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (“SUPPORT”) for Patients and Communities Act was signed into law.  The SUPPORT Act aims to reduce the number of Americans impacted by opioid addictions and develop alternative treatments.  Additionally, the SUPPORT Act requires that the DEA to promulgate final regulations, specifying the limited circumstances where controlled substance may be prescribed via telemedicine, and having a special registration for such telemedicine organizations. However, to date, the DEA has not issued any regulations for the special registration for telemedicine. In the interim, many state legislatures have now passed their own laws to address the issue of remote prescribing of controlled substances.

This is a complicated emerging area of law that will impact any entrepreneur attempting to duplicate the Amazon Effect for prescriptions.  As such, prescribers need to be cautious and understand the nuances of individual state law before prescribing controlled substances, or they could be in violation of not only state but federal law. To schedule a consult or to better understand telemedicine, contact us at info@byrdadatto.com.

ByrdAdatto Founding Partner Bradford E. Adatto

Bradford E. Adatto

Brad decided to become a lawyer during sixth-grade Career Day, when he promised to represent his best friend, a future doctor. A few decades later, he started his own law firm that focused on representing health care and corporate clients.

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