Controlled Substance Act:
- Summary: States are allowed to do what they want and enact own CSA laws. DEA is involved with CSA. (DLU 02/05/2021)
- Gabapentin is considered a controlled substance in AL, KY, MI, ND, TN, VI, and WV.
Ryan Haight Act (2008): https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/toolkit/ryan-haight-act
● The Act requires any practitioner issuing a prescription for a controlled substance to conduct an in-person medical evaluation (with certain specified exemptions). A conservative recommendation to support compliance with the act is to conduct an in-person exam at least once every 24 months.
● The Act also describes special circumstances such as covering prescribers, and prescribing within a federal health care system (e.g. Indian Health System; Department of Veteran’s Affairs). Psychiatrists working in federal health care systems should be familiar with their organization’s policy around the telepsychiatric prescribing of controlled substances.
● Waived in 2020 due to COVID-19
SUPPORT Act (2018):
● For schedule III, IV, or V – this works not Schedule II
● Allows up to 100 MAT subscribers in year 1
● Up to 275 thereafter assuming no violations
● Allows nurse practitioners and physician associates to provide as well (permanently)
● Good until 2023 – temporarily (until October 1, 2023) expanding the definition of a “qualifying practitioner” to also include a clinical nurse specialist, certified registered nurse anesthetist, or a certified nurse midwife who meets certain qualifications set forth in 21 U.S.C. 823(g)(2)(G)(iv), allowing more flexibility. Those qualifications for clinical nurse specialists, certified registered nurses, or certified nurse midwives, pertaining to training, experience, and supervision, are the same as those that previously only applied to nurse practitioners or physician assistants. (Federal Register)
TREATS Act (2021):
● Good overview of Telehealth waivers for Bup https://www.healthaffairs.org/do/10.1377/hblog20200910.498716/full/
● Portman, (R-OH) introduced in 2021 https://www.govtrack.us/congress/bills/117/s340
● Would enable long-term telehealth for buprenorphine rather than just in crisis
● THIS HAS NOT PASSED YET (Phase: Intro Senate 02/21/2021)
CARA Act (2021):
● Also by Portman (R-OH)
● $800M for addiction recovery
● Requires to be in the same state as the patient but can do telehealth MAT
● Permanently allows providers to prescribe medication-assisted treatment and other necessary drugs without a prior in-person visit, and to bill Medicare for audio-only telehealth services. (2.0)
● THIS HAS NOT PASSED YET (Phase: Intro Senate 03/25/2021)