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The DEA plans to reinstate federal requirements that patients see a doctor in person before receiving prescriptions for Schedule III drugs. During the declared COVID-19 public health emergency, the DEA had waived the requirement, but with the Biden Administration announcing it will end the public health emergency May 11, the DEA plans to end the pandemic-era exemption, too. The announced change garnered more than 35,000 comments in the one-month public comment period. The DEA’s goal is to prevent overprescribing of controlled medications, but the end of the exemption will impact those with prescriptions for ADHD, gender-affirmative hormone therapy, and opioid recovery medications.

In Humboldt, reinstating the rule is expected to impact rural residents and create longer wait times at already impacted healthcare centers. The Humboldt Area Center for Harm Reduction (HACHR) warns it will also result in fewer people seeking much-needed treatment for opioid use, while Open Door Community Health Centers Executive Officer Tory Starr said he has “significant concerns” with the language of the amendment. Open Door provided the DEA with comments regarding its concerns, joining the National Association of Community Health Centers, the California Primary Care Association, the California Medical Association and the American Medical Association.

“We understand the government wanting to prevent the true ‘pill mills’ that cause harm to patients within our system,” Starr said.“However, the proposed rule would have a negative impact, especially in rural areas with limited access to services. We have significant concerns with the current language.”

In a DEA press release, United States Health and Human Services Secretary Xavier Becerra acknowledged the importance of telemedicine in rural communities nationwide.

“Improved access to mental health and substance use disorder services through expanded telemedicine flexibilities will save lives,” he said. “We still have millions of Americans, particularly those living in rural communities, who face difficulties accessing a doctor or health care provider in person.”

Yet the DEA’s removal of the exemption May 11 will mean patients who have depended on telemedicine for their prescriptions will soon have to see their provider in person at least once in order to continue receiving them.

HACHR Board Chair Jessica Smith, who also works as a public health analyst with the research organization RTI International, said access to medication for opioid use disorder (MOUD) is essential to prevent overdosing and combat the opioid crisis. Buprenorphine, commonly called suboxone, is a Schedule III medication used to treat opioid use disorder by preventing withdrawal symptoms.

“People who use opiates are often seeking them from the street, an unregulated drug supply. We know there are all sorts of garbage in it, including Fentanyl,” Smith said. “Not quite knowing the amount of what you're getting makes it easy to overdose, but Buprenorphine — it's a controlled, regulated substance. So people know what they're getting.”

Smith described telehealth as a game changer for Humboldt. It improves access for rural communities and also helps to reduce stigma.

“HACHR offers a program in Hoopa that offers an MOUD program on the reservation, specifically run by and for Native folks,” she said. “Besides HACHR, the only other program offering MOUD is K'ima:w. They're in an even smaller community. Everybody knows everybody. So if you show up to the clinic, and that's your aunt's best friend or your cousin, maybe you don't want that person knowing that you're needing treatment for opioid use.”

Beyond stigma, many people in rural Humboldt communities seeking treatment have physical barriers to accessing MOUD prescriptions. Those living in the far stretches of Humboldt who previously relied on telehealth for their MOUD will have to plan further ahead to access treatment. Some also worry the resulting influx of patients seeking in-person appointments for their prescriptions may also impact patients seeking other healthcare, as providers account for an increased number of in-person patients.

“There are still barriers to getting medication for us in rural communities. We have limited providers, in general, for all of our healthcare needs,” Smith said. “People who have transportation barriers still need to get to a doctor to be able to access medication.”

The DEA has acknowledged the restriction would have a more significant impact on rural communities. The agency’s proposal does allow practitioners to prescribe a limited amount of Buprenorphine through telehealth, but it has not made any further exceptions for transgender patients seeking testosterone prescriptions, medications for those with attention deficit disorder and others.

“DEA is committed to ensuring that all Americans can access needed medications,” said DEA Administrator Anne Milgram. “DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm.”

Ollie Hancock (they/them) is a staff writer at the Journal. Reach them at (707) 442-1400, extension 317, or [email protected].