A patient in rural West Texas is struggling with opioid addiction. There are no local psychiatrists, so the patient needs telemedicine for the counseling and prescriptions he needs. There's just one problem: U.S. Drug Enforcement Administration (DEA) regulations on e-prescribing are vague and could leave a treating physician in legal jeopardy.
To address this situation — and others like it — the Texas Medical Association will try to persuade the American Medical Association (AMA) to adopt policy to let psychiatrists e-prescribe medications when a telemedicine relationship has been established.
The proposed policy, approved during the Texas Medical Association’s TexMed 2018 annual meeting in May, is designed to remove legal ambiguities at the federal level created by DEA rules and the federal Ryan Haight Act.
"Those laws were originally made in order to prevent internet pill mills from distributing pills without meeting a standard of care and establishing a good doctor-patient relationship," said Austin psychiatrist Elizabeth Truong, MD, who wrote the initial proposal. "There's a lot of nervousness out there by physicians because they want to protect their DEA and their board license on prescribing controlled medicines."
In 2017, the Texas Legislature — with TMA's support — passed Senate Bill 1107, which created a more clear-cut legal framework for telemedicine to operate in Texas.
The need for telemedicine in psychiatry is especially acute because the United States and Texas both have a chronic shortage in that specialty.
In 2017, a report by the National Council of Behavioral Health said 77 percent of U.S. counties reporting a severe psychiatrist shortage. According to Merritt Hawkins, the physician search and consulting firm, Texas is 41st among states in psychiatrists per capita, with 5.81 per 100,000 people.
"One of the biggest [issues] is the opioid crisis," Dr. Truong said. "There are very, very few prescribers here in Texas who can prescribe things like Suboxone or feel comfortable with medication-assisted therapies. To be able to get care to a lot of these rural counties where there aren't psychiatrists, period, to do any kind of medication-assisted therapy is really, really tough."
TMA introduced the proposal at the AMA House of Delegates annual meeting, which convenes this weekend in Chicago.
Dr. Truong said the resolution focuses on psychiatry because it already has a strong track record in treating patients remotely in prisons and other settings.
"For psychiatrists, it's a lot easier to do telemedicine than a lot of other specialties," she said. "I think it's a good start. … It could mean the expansion of telemedicine in other ways."
The AMA is the national physician association that uses state and national advocacy to enable a better health care system for patients, physicians, and the country. TMA members are encouraged to join or renew their membership to ensure that Texas physicians are well represented in national health care issues.