During the COVID-19 pandemic, the need for mental health services has exploded. The week COVID-19 was declared a pandemic the prescriptions filled for anti-anxiety, anti-insomnia, and antidepressants went up 21%. During the course of the pandemic itself, we are seeing an increase in the use of non-prescribed fentanyl by 32%, methamphetamine by 20%, and alcohol sales going up by over 25%. Additionally, suspected drug overdoses increased by 18%. The need for effective mental health services has never been more acute.
COVID-19 has forced us to conduct as much of our lives as possible remotely, this includes our medical appointments. As of March 17, 2020, the Ryan Haight Act has been suspended by the Drug Enforcement Administration (DEA). The Ryan Haight Act requires a provider to conduct an initial in-person examination of a patient before any controlled substance can be prescribed to the patient. The act itself was passed in 2008 to regulate online prescribing as there has been a rise at the time of adolescents in particular accessing prescription-controlled substances through the internet for non-medical purposes. Technology has become vastly more sophisticated since the act’s passing. With most medical records online, electronic prescribing, and the ability for providers to connect with patients through high quality two-way interactive video, forcing in-person visits for a practitioner to prescribe a mental health drug does not make logistical sense. Importantly, oftentimes the medications for mental health conditions, such as anxiety and depression, are controlled substances. The DEA classifies controlled substances in regard to medications to have a certain or higher potential to be abused or cause addiction.
Allowing a patient to access mental health care from their home offers patients more options and is more amenable to those who have conditions that might make it difficult for them to leave their homes. Beyond this, moving appointments online during the pandemic has shown that many of the appointments we conduct in person can be done just as, if not more, effectively through telemedicine. Telemedicine is more cost effective and more convenient for doctors and patients alike for certain medical issues. In fact, 87% of patients found telemedicine visits more convenient and 84% of patients found it improved their relationship with their physician.
The actual difference between an in-person visit and a telemedicine synchronous two-way visit is minimal and in fact psychiatrists reported improved outcomes for telemedicine patients. With telemedicine care, patient attendance increased and 85% of people who visited psychiatrists for the first time online were satisfied with their visit. In addition, studies have shown that when patients keep their first appointment they are more likely to keep subsequent appointments, continue treatment, and are overall more satisfied with their treatment. Further, research shows that the above results create better medication compliance, few visits to emergency rooms, and fewer readmissions to inpatient units.
Armed with these statistics, the American Psychiatry Association has recommended that once the Ryan Haight Act is no longer suspended, the act should be amended to allow physicians to prescribe these prescription-controlled substances through first time psychiatry telemedicine visits. Legislation needs to keep up with and respond to improvements in patient care and patient needs. Oftentimes there is a disconnect between the law and medicine as in terms of what is best for patient safety and the abilities of technology, and COVID-19 has made these discrepancies even more apparent. It has prompted an examination of previous telemedicine laws. The suspension and alteration of the Ryan Haight Act during COVID-19, especially, makes us ask if this sweeping law truly helps patients. In response the outcry from the APA and others in the medical community, the DEA did update the law in September of 2020, but did not remove the in-person requirement. Instead, it introduced a registration system for physicians to register for telemedicine privileges; however, they have not further elucidated how or when this system will be implemented.The introduction of special telemedicine designation is a start to remedying this issue, but the DEA needs to prioritize and inform physicians how they can register for this designation. This lack of clarity could result in uncertainty for physicians who could then not prescribe needed medication to a patient due to licensing and regulatory concerns. The mental health crisis in this country cannot be addressed properly if patients cannot access the medication they need safely in the pandemic, nor can it be addressed otherwise by making these medications highly inaccessible in settings that do not warrant it. Telemedicine psychiatry for most patients should be the accepted practice and the law needs to recognize this in order to help physicians to put their patients first.