The Arizona Telemedicine Program Blog

I think we all know by now that the pandemic has led to a dramatic surge in the use of telehealth. In Arizona, that was partly thanks to several executive orders our governor signed in March and April of 2020 expanding telehealth coverage and flexibilities for the duration of the public health emergency. (Scroll to Executive Orders 2020-07, 2020-15, and 2020-29.)

Telemedicine and the technologies that provide the service delivery have swiftly become the essential, everyday apparatus keeping the US healthcare system afloat in 2020. Patients have adapted well to the rapid switch to teleconferencing appointments and assessments with their general practitioner.

HIPAA compliance is difficult to achieve under normal circumstances but during a global pandemic, healthcare institutions have faced an uphill struggle. As hospitals, practices, and clinics closed, a seismic shift towards telemedicine was embarked upon. For many healthcare entities, this was something completely new, for others it was a simple change of routine.

A storm surge and a tsunami are vastly different entities. A storm surge is an oceanic phenomenon resulting from the piling up of surface water from the sustained pressure of wind in a storm.  Damage, in human terms, is typically limited to structures along the coastline. A tsunami is a very different phenomenon.  Often caused by a natural disaster such as an underwater earthquake or volcanic eruption, the tsunami carries enormous energy in the form of a sheet of water spanning the ocean’s surface down to its floor.  Its devastation can disrupt the fabric of society deep inland.

In last week’s blog, I discussed Drug Enforcement Agency limitations on the use of telemedicine to prescribe controlled substances. To summarize the restrictions, the DEA requires that any prescription of a controlled substance must be issued by a practitioner who has conducted at least one in-person medical evaluation of the patient, with a few, very complicated exceptions.

During the COVID-19 Public Health Emergency, the DEA has relaxed these restrictions and is allowing telehealth evaluations to substitute for in-person evaluations. Sara Gibson, MD, a Flagstaff-based telepsychiatrist, last week discussed the impacts of the restrictions and waivers on patients in underserved areas with opioid use disorder. Today, she points out another at-risk population affected by the DEA prescribing restrictions outside of the PHE.

Since the COVID-19 Public Health Emergency (PHE) was declared in January, the use of telehealth has skyrocketed. This is in part because many restrictions on it have been lifted for the duration of the PHE in order to make healthcare services more accessible to patients while maintaining physical safe distance. Some of the temporarily waived restrictions include Drug Enforcement Agency limitations on the use of telemedicine to prescribe controlled substances.

Normally, the DEA requires that any prescription of a controlled substance be issued by a DEA-registered practitioner who has conducted at least one in-person medical evaluation of the patient, with a few exceptions. These include the patient being located in and treated by a DEA-registered hospital or clinic or the patient being in the physical presence of another DEA-registered practitioner during the evaluation.