Mar 7, 2023 - Podcasts

A DEA crackdown on telehealth prescribing

The DEA has proposed new rules that would require doctors to see patients in person before they can prescribe medications like OxyContin and Adderall. The rules would also impact medications like buprenorphine, which is used to treat opioid addiction.

  • Plus, San Francisco weighs a hefty reparations plan.

Guests: Axios' Sabrina Moreno and Megan Rose Dickey.

Credits: Axios Today is produced by Niala Boodhoo, Alexandra Botti, Naomi Shavin, Lydia McMullen-Laird and Alex Sugiura. Music is composed by Evan Viola. You can reach us at [email protected]. You can text questions, comments and story ideas to Niala as a text or voice memo to 202-918-4893.

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Editor's note: This episode has been corrected to reflect that OxyContin is one of the drugs that would be affected by new proposed DEA rules for remote prescribing, not oxytocin.


NIALA: Good morning! Welcome to Axios Today!

It’s Tuesday, March 7.

I’m Niala Boodhoo.

Here’s what we’re covering today: San Francisco weighs a hefty reparations plan.

But first, a DEA crackdown on telehealth prescribing – that’s today’s One Big Thing.

NIALA: The DEA proposed new rules last week that would require doctors to see patients in person before they can prescribe medications like oxytocin and Adderall.

Axios, Sabrina Moreno has been reporting on what these proposed changes can mean for behavioral health and addiction treatment.

So Sabrina, what exactly is the DEA proposing?

SABRINA MORENO: The DEA is proposing a change to those pandemic inspired policies that allowed patients to access some controlled substances like Adderall or OxyContin via telehealth even if a person has never seen the doctor in person, and so now some patients will be required to have that in-person visit before getting a refill on their medication. But the only exception is for buprenorphine, which is used to treat opioid use disorder and can really reduce the risk of future overdoses. Folks who are on that are able to have a 30 day refill before seeing their provider in person or being required to do that. That's if they have never seen their provider in person.

NIALA: Sabrina what's the catalyst behind these proposed changes?

SABRINA: So this is actually something that's been in the works for a really long time. Clinicians and providers have really been wanting a lot more clarity on what remote prescribing might look like, and this is even before the pandemic. So the DEA's overarching goal is to set guardrails to what prescription looks like via telehealth. So patients can be safe, and so the risk is limited. However, the pushback to that is that even though that might be the DEA's goal, providers are saying that what could actually happen is a reduced access to care and what could happen if that care is disrupted, if that treatment is disrupted, so it's kind of one of those things where it's this unintended consequence that can potentially be a deadly one.

NIALA: Sabrina, just from a common sense standpoint, that sounds like that makes a lot of sense what the DEA is proposing, but what are behavioral experts in addiction treatment experts telling you about the reality of what these proposals might mean for people?

SABRINA: Yeah. So even though this is less restrictive than before the pandemic, you know, the pandemic kind of offered this real time experiment of what was possible in increasing access to medication that people needed. These pandemic policies that allowed for buprenorphine to be prescribed via telehealth was actually something that led to increased prescriptions. So now what people are saying is that this could actually be something that exacerbates the overdose crisis, you know, and we're already seeing more than a hundred thousand Americans every single year die from overdoses. And making it so people have to see someone in person can be a really difficult hurdle for some people to overcome, especially if they're in rural aspects of the state if they are disabled things like that. And then the other aspect of this is a concern that people might turn to even deadlier street drugs if they can't access prescription. However, there is kind of a a mini divide, which is also experienced in reporting this out, what most people were saying is that they wish that the addiction medication was held separate from that oversight on adderall and Xanax because they were saying, you know, not having your Adderall won't necessarily kill you. Whereas a person who's relying on buprenorphine to help their opioid use disorder and they're seeking this treatment that can really be detrimental it can really make people fall back and, and, and regress. And one person actually told me, you know, that the fallout is gonna be measured in lives lost.

NIALA: So these are proposals. Are we expecting then pushback from different behavioral health professionals to these proposals?

SABRINA: If you look up the proposed rules on the federal register, there's already more than 200 people responding, and most of them are saying that this is not the greatest idea and that it's too restrictive.

NIALA: What happens when this 30 day open common period ends?

SABRINA: We are expecting that the DEA will provide their final guidance. And you know, what providers were telling me was, they're not really sure what what's gonna happen and, and if the draft guidance actually just ends up being the final guidance.

NIALA: Sabrina Moreno is a healthcare reporter for Axios. Thanks Sabrina.

SABRINA: Thank you.

In a moment: San Francisco's proposed plan for reparations.

San Francisco weighs a hefty reparations plan

NIALA: Welcome back to Axios Today, I'm Niala Boodhoo. The city of San Francisco has a proposed reparations plan that would give each eligible Black resident a one-time payment of 5 million dollars. The African-American Reparations Advisory Committee will be presenting at the city's Board of Supervisors meeting today to discuss how the city can make amends for the lack of opportunities and displacement of its black population. Axios says Megan Rose Dicky has been covering the story and is joining us now from San Francisco. Megan, how did the committee come up with this $5 million figure?

MEGAN ROSE DICKY: There's not a concrete formula, but basically the committee looked at the history of injustices that have happened to the Black community in San Francisco and decided that the $5 million would be a meaningful amount.

NIALA: And so who actually is eligible for this $5 million?

MEGAN ROSE: First and foremost, you have to be at least 18 years old. You have to have identified as Black or African American on public documents for at least 10 years. In addition to that, someone would also need to prove at least two other elements. So like, for example, they were born in San Francisco, between 1940 and 1996 and lived in the city for at least 13 years. Or maybe they were someone who was displaced by the urban renewal of the sixties and seventies, or a direct descendant of someone displaced.

NIALA: Megan, let's talk about that displacement, because in 1970, Black people made up around 13% of San Francisco's population, but in 2021, the number had dropped to nearly 6%. How did that happen?

MEGAN ROSE: The urban renewal definitely played a large part of that. So the Fillmore District, which was an area targeted by the urban renewal was a predominantly Black neighborhood. That area alone, during the redevelopment there, about 5,000 households displaced and 20,000 lives damaged. And this is according to the reparations committee. So of course, like that's not the only reason why the population has declined. I mean, the city is known for its high cost of housing .Um, there are, of course, elements at play, whether it's just, discrimination in education and schools and banking, making it harder for black people to get loans. There's a lot going on in the city, but, um, the, the urban renewal was definitely kind of, the tipping point.

NIALA: What have you heard from people in San Francisco about this reparation plan?

MEGAN ROSE: There are definitely reviews on it. a lot of focus on the 5 million. San Francisco has a very large projected budget deficit over the next few years. So a lot of people are wondering like, okay, well where is this money going to come from? Like, is this just going to totally bankrupt the city? But then on, on the other side, I mean, there are definitely some people who feel like 5 million would be great, but is that actually even enough money? There's still quite a process up ahead and the committee has until June to sort of take in everything that they're hearing and then submit a final recommendation. From there, then it's up to the city leaders to decide.

NIALA: Evanston, Illinois is credited with having America's first government funded reparations program. How do you think what's happening right now in San Francisco is gonna affect the reparations conversations that are happening in other cities around the country?

MEGAN ROSE: Yeah. It's interesting because I saw recently in Detroit they're forming a reparations committee. I think we're gonna see a lot of cities and states sort of looking at what the others are doing, but ultimately coming up with something that they feel like works best for them, with different historical contexts.

NIALA: So I think it's natural for people to sort of glom onto the $5 million figure. But to your mind is the more important aspect of this, that this might actually happen?

MEGAN ROSE: Technically I'm eligible for these reparations. Do I think I'm going to get $5 million? Not necessarily, but I do think that there will be some sort of reparations. There's already so much buy-in from local leaders, that's already one hurdle that's been overcome.

But I think now the hurdle is, how do you actually like get this across the finish line?

NIALA: Megan Rose Dickey is an Axios local reporter in San Francisco. Thanks Megan.

MEGAN: Thanks for having me.

NIALA: That’s all we’ve got for you today!

I’m Niala Boodhoo - thanks for listening - stay safe and we’ll see you back here tomorrow morning.

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