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Saint Louis University Journal of Health Law & Policy

Document Type

Student Comment

Abstract

The COVID-19 Public Health Emergency (COVID-19 PHE) spurred changes in healthcare delivery, greatly increasing telemedicine utilization and resulting in temporary exceptions to the Ryan Haight Act (RHA). These exceptions allowed limited prescriptions of controlled substances through telemedicine without a prior in-person patient evaluation. Research indicates that these relaxed prescribing standards did not lead to an increase in overdose related deaths, specifically with respect to drugs like buprenorphine administered in opioid use disorder (OUD) treatment, instead improving access and retention outcomes. However, in anticipation of the COVID-19 PHE’s end, in 2023 the Drug Enforcement Administration (DEA) released notices of proposed rulemakings (NPRMs) that would greatly roll back flexibilities, generating debate within the health care industry. This Note provides an overview of telehealth prescribing regulation before, during, and after the COVID-19 PHE. Additionally, this Note discusses concerns, voiced by providers and entities involved in the telehealth realm, during the notes and comments period for these 2023 NPRMs. Many criticized these initial NPRMs as problematic due to unclear terminology, burdensome recordkeeping requirements, ineffective diversion prevention safeguards, perceived intrusion into medical judgement, and other shortcomings that could deter the provision of appropriate care. Although the most recently released 2025 NPRMs appear to address some initial concerns, including the long-awaited special registration process, this health care space still requires substantial refinement. Ultimately, this Note argues for maintaining relaxed prescribing standards for buprenorphine in specific practice areas like addiction medicine and psychiatry, where telehealth has proven its ability to increase healthcare access and treatment retention safely and responsibly.

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