A proposed rule by the Drug Enforcement Administration (DEA) that would ban medical practitioners from prescribing controlled medications via telemedicine if they have not conducted an in-person medical evaluation beforehand would worsen suffering for patients at the end of life, according to end-of-life care advocates.

“While we recognize the necessity of reducing harm from the illegal diversion of controlled substances, the proposed rule is not balanced and creates a substantial barrier to access and comes at the expense of those at the end of life,” said Kim Callinan, president/CEO of Compassion & Choices in a letter to the DEA Administrator Anne Milgram. “…[T]he DEA has taken an overly broad approach — limiting telemedicine for all populations rather than focusing on risks of misuse. We request significant modifications to reduce that negative impact, including processes that do not burden already-overwhelmed practitioners, who care for patients with serious illnesses, especially those at the end of their lives, with additional layers of record-keeping and referrals that do not improve quality of care.” 

Friday, March 31, is the deadline for public comments on the DEA’s proposed rule: “Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation.”

“Roughly 1.5 million Americans are homebound seniors who either benefit from receiving prescriptions via telemedicine or could benefit from telemedicine through a reduction in barriers to access it,” said Dr. Michael Fratkin, a palliative care physician, pioneer of telemedicine and member of Compassion & Choices’ Healthcare Advisory Council. “Homebound patients are disproportionately Hispanic and Black non-Hispanic, medically and socially complex, and isolated. Telemedicine increases access and reduces barriers to end-of-life care, including hospice care for patients with a prognosis of six months or less to live.”

Compassion & Choices and Dr. Fratkin urged the DEA to make two changes to the proposed telemedicine prescription rule:

1. An exemption from the in-person exam requirement could be made available to people at the end of life. Due to increasing refusals of care based on healthcare systems’ and medical practitioners’ religious or conscience-based objections, patients at the end of life have warranted concerns that the proposed referral process would not fully support their access to services and medications. Thus, a referral may only be suitable when it is reasonably possible for a patient to access care for an in-person exam and the practitioner agrees to a referral as requested by the patient.
2. Unless the patient faces more risks than benefits in traveling to see a medical practitioner, the rule could include location-based limits. For example, it could allow telemedicine prescribing without an in-person exam if the needed practitioner is located more than 30 miles from the patient (16% of Americans who live in the mainland United States are 30 miles or more away from the nearest hospital, a distance that can make the difference between life or death.)

The link to the Compassion & Choices entire letter to Drug Enforcement Administration Administrator Anne Milgram is at: bit.ly/CandCreDEAproposedTelemedicinePrescriptionRule

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