Teleprescribing Controlled Substances: Flowchart Analysis of the Ryan Haight Act and State Telemedicine Laws

Lingam, Harish A.; Caudill, Robert

doi:10.1007/s41347-019-00100-2

Cited by 7 publications

(6 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Telemedicine is a tool to expand the reach of addiction specialists and integrate addiction treatment into obstetric care. However, legislation originally intended to prevent the prescribing of controlled substances via the internet has hindered progress in the use of telemedicine for the treatment of OUD nationally due to an in-person visit requirement . Current legislation has called for the revising of laws governing the prescribing of controlled substances via telemedicine .…”

Section: Introductionmentioning

confidence: 99%

“…However, legislation originally intended to prevent the prescribing of controlled substances via the internet has hindered progress in the use of telemedicine for the treatment of OUD nationally due to an in-person visit requirement . Current legislation has called for the revising of laws governing the prescribing of controlled substances via telemedicine . Yet, there are few empirical data to guide these revisions and, to our knowledge, there have been no studies describing a telemedicine program for the treatment of OUD in pregnant women.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine

et al. 2020

View full text Add to dashboard Cite

IMPORTANCE There are high rates of maternal and newborn morbidity and mortality associated with opioid use disorder (OUD). Integrating OUD treatment in obstetric practices for pregnant and postpartum women via telemedicine can increase access to care and reduce the consequences of OUD. Evaluation of this care delivery model, however, is needed before widespread adoption.OBJECTIVE To compare maternal and newborn outcomes among pregnant women with OUD receiving care via telemedicine vs in person. DESIGN, SETTING, AND PARTICIPANTSA nonrandomized controlled trial including 98 women receiving perinatal OUD treatment in 4 outpatient obstetric practices by telemedicine or in person and followed up until 6 to 8 weeks post partum was conducted from September 4, 2017, to December 31, 2018. Logistic regression with propensity score adjustment was applied to reduce group selection bias and control for potentially confounding variables.INTERVENTIONS Participants were seen weekly for 4 weeks, every 2 weeks for 4 weeks, and monthly thereafter and provided relapse prevention therapy and buprenorphine. MAIN OUTCOMES AND MEASURESThe outcomes were retention in treatment, defined as uninterrupted addiction treatment during pregnancy through 6 to 8 weeks post partum; urine drug screen results at delivery and 6 to 8 weeks post partum; and a neonatal abstinence syndrome (NAS) diagnosis collected via electronic health records. RESULTSThe mean (SD) age of the 98 pregnant women was 30.23 (5.12) years. Of these, 41 of 44 women (93.2%) in the telemedicine group and 48 of 54 women (88.9%) in the in-person group chose to continue treatment in the program after an initial evaluation. After propensity score weighting and doubly robust estimation, no significant differences were found between groups in retention in treatment at 6 to 8 weeks post partum (telemedicine: 80.4% vs in person: 92.7%; treatment effect, −12.2%; 95% CI, −32.3% to −4.4%). Similarly, after propensity score weighting and doubly robust estimation, there were no significant group differences in rates of NAS (telemedicine: 45.4% vs in person: 63.2%; treatment effect, −17.8%; 95% CI, −41.0% to 8.9%). CONCLUSIONS AND RELEVANCEIn this nonrandomized controlled trial, virtually integrated OUD care in obstetric practices produced similar maternal and newborn outcomes compared with in-person care. These findings may have important public health implications for combatting the opioid crisis and its consequences on pregnant women and their families. Future large randomized clinical trials are needed. (continued) Key Points Question Is opioid use disorder treatment received via telemedicine in obstetric practices associated with similar maternal and newborn outcomes compared with opioid use disorder treatment received in person in obstetric practices? Findings In this nonrandomized controlled trial including 98 pregnant women with opioid use disorder, there were no statistically significant differences in rates of retention in treatment between women receiving opioid use disorder treatme...

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine

et al. 2020

View full text Add to dashboard Cite

show abstract

“…These frameworks are not only often legally mandated but are also often perceived as synonymous with good clinical practice [ 67 ]. Examples of regulatory restrictions that require particular attention in the development of TMOUD include regional prescription drug monitoring programs to limit the risk of inappropriate provision of a medication that could cause dependency and mandatory in-person consultations before the provision of MOUD [ 27 , 68 , 69 ]. However, growing evidence has shown that overregulation results in barriers to MOUD provision, pushing some patients into the illicit market to manage opioid withdrawal [ 70 ].…”

Section: Resultsmentioning

confidence: 99%

“…For example, because of nonnegotiable prescribing arrangements for several controlled drugs, including methadone, India was unable to implement TMOUD in any meaningful way [ 38 ] compared with its North American counterparts [ 27 , 64 , 69 , 72 ]. Other important regulatory considerations include reimbursement arrangements and payment parity between telemedicine and in-person consultations [ 27 , 68 , 69 , 73 , 74 ], information governance safeguards [ 38 , 68 ], the availability of sanctioned telemedicine platforms [ 66 , 75 ], and medical indemnity coverage for physicians [ 62 , 68 ].…”

Section: Resultsmentioning

confidence: 99%

Developing a Theoretically Informed Implementation Model for Telemedicine-Delivered Medication for Opioid Use Disorder: Qualitative Study With Key Informants

Tay Wee Teck,

Gittins,

Zlatkute

et al. 2023

JMIR Ment Health

View full text Add to dashboard Cite

Background Telemedicine-delivered medication for opioid use disorder (TMOUD) has become more prevalent during the COVID-19 pandemic, particularly in North America. This is considered a positive development as TMOUD has the potential to increase access to evidence-based treatment for a population heavily affected by the opioid crisis and consequent rising mortality and morbidity rates in relation to opioid use disorder. Despite the increase in the use of TMOUD, there are no established service- and process-focused models to guide the implementation of this intervention. Objective This study aims to develop a process- and service-focused implementation model in collaboration with key stakeholders and bring together peer-reviewed literature, practice-based knowledge, and expert opinions. Methods The simple rules for evidence translation in complex systems framework was applied to guide the development of a 6-step qualitative study. The steps were definition of the scope and objectives of the model, identification of evidence, stakeholder engagement, draft model development, key informant consultation, and final model specification. Results The final specification for the TMOUD implementation model incorporated key strategic priorities, service delivery prerequisites, service design elements, stakeholder identification and engagement, key process domains, and iterative cycles of evaluation and improvement. Conclusions Through stakeholder engagement and key informant consultation, we produced a process- and service-focused TMOUD implementation model. The model is modifiable to different contexts and settings while also in keeping with the current evidence base and national and international standards of high-quality opioid use disorder care.

show abstract

“…The Ryan Haight Act restricted DTC telemedicine physicians from prescribing controlled substances for patients in the absence of an in-person evaluation during the study period. 33 Some controlled substances, like methylphenidate and buprenorphine, are commonly used treatments for certain mental health conditions and were not prescribed via DTC telemedicine.…”

Section: Methodsmentioning

confidence: 99%

Use of Direct-to-Consumer Telemedicine to Access Mental Health Services

et al. 2022

View full text Add to dashboard Cite

Background The coronavirus disease 2019 pandemic has contributed to growing demand for mental health services, but patients face significant barriers to accessing care. Direct-to-consumer(DTC) telemedicine has been proposed as one way to increase access, yet little is known about its pre-pandemic use for mental healthcare. Objective To characterize patients, providers, and their use of a large nationwide DTC telemedicine platform for mental healthcare. Design Retrospective cross-sectional study. Setting Mental health encounters conducted on the American Well DTC telemedicine platform from 2016 to 2018. Participants Patients and physicians. Main Measures Patient measures included demographics, insurance report, and number of visits. Provider characteristics included specialty, region, and number of encounters. Encounter measures included wait time, visit length and timing, out-of-pocket payment, coupon use, prescription outcome, referral receipt, where care otherwise would have been sought, and patient satisfaction. Factors associated with five-star physician ratings and prescription receipt were assessed using logistic regression. Key Results We analyzed 19,270 mental health encounters between 6708 patients and 1045 providers. Visits were most frequently for anxiety (39.1%) or depression (32.5%), with high satisfaction (4.9/5) across conditions. Patients had a median 2.0 visits for psychiatry (IQR 1.0–3.0) and therapy (IQR 1.0–5.0), compared to 1.0 visit (IQR 1.0–1.0) for urgent care. High satisfaction was positively correlated with prescription receipt (OR 1.89, 95% CI 1.54–2.32) and after-hours timing (aOR 1.18, 95% CI 1.02–1.36). Prescription rates ranged from 79.6% for depression to 32.2% for substance use disorders. Prescription receipt was associated with increased visit frequency (aOR 1.95, 95% CI 1.57–2.42 for ≥ 3 visits). Conclusions As the burden of psychiatric disease grows, DTC telemedicine offers one solution for extending access to mental healthcare. While most encounters were one-off, evidence of some continuity in psychiatry and therapy visits—as well as overall high patient satisfaction—suggests potential for broader DTC telemental health use. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-07326-y.

show abstract

Teleprescribing Controlled Substances: Flowchart Analysis of the Ryan Haight Act and State Telemedicine Laws

Cited by 7 publications

References 33 publications

Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine

Treatment of Opioid Use Disorder in Pregnant Women via Telemedicine

Developing a Theoretically Informed Implementation Model for Telemedicine-Delivered Medication for Opioid Use Disorder: Qualitative Study With Key Informants

Use of Direct-to-Consumer Telemedicine to Access Mental Health Services

Contact Info

Product

Resources

About