The Telehealth Precipice: Congress Must Act Now to Guarantee Access to Mental Health, SUD Care

As America emerges from the pandemic, it has become frighteningly clear to what extent the pandemic has exacerbated an already deepening mental health and substance use crisis. According to the Substance Abuse and Mental Health Services Administration (SAMHSA)About one in five adults, or 50 million people in the United States, suffered from a mental illness in 2020, and 40 million Americans suffered from a substance use disorder.

Unfortunately, the crisis continues to worsen because many Americans do not have access to mental and behavioral health services. More than 150 million Americans live at a mental health provider scarcity areas. As a Outcomemany people simply do not receive care.

In response, Congress and the federal government have embraced telehealth as a solution to this severe lack of access to treatment for mental health illnesses or substance use disorders. Telehealth removes barriers such as distance, cost, and staff shortages and allows providers to offer services to people who might not otherwise have access.

One specific area where access was improved is a result of waivers granted by the Drug Enforcement Agency (DEA) during the pandemic. These waivers allow qualified physicians to prescribe some controlled medications used specifically to treat substance use disorder after conducting a telehealth examination. This waiver has been in place for more than two years and research has shown that it has provided significant benefits to patients. A to study published in the Journal of the American Medical Association concluded that “use of telehealth during the pandemic was associated with better retention in care and less likelihood of medically treated overdose…”

Unfortunately, the future of telehealth remains uncertain. If Congress does not act by the end of the year, these important telehealth flexibilities will expire when the public health emergency ends, leaving thousands of patients without access to mental health and substance use disorder treatment. There are two ways Congress can avoid this “telehealth cliff” in time.

Congress could pass legislation like the bill I introduced, the bipartisan “Telehealth Response to the Electronic Prescription Addiction Therapy Services Act” (also known as the TREATMENTS Act, HR 1647)” which would preserve the DEA telehealth prescription exemptions.

Alternatively, Congress could extend the DEA telehealth prescription waiver for at least one year after the public health emergency ends. Two current laws direct the DEA to establish a special Registry for providers to prescribe controlled substances via telehealth: (1) the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (Ryan Haight Act) and (2) the SUPPORT for Patients and Communities Act of 2018 (SUPPORT Law).

Finally, after a long delay, the DEA submitted a proposed rulemaking to the Office of Management and Budget (OMB) in March 2022, where it remains today. With the public health emergency expected to end in 2023, Congress could temporarily preserve the DEA’s current telehealth waivers through a one-year extension, allowing the rulemaking process to be completed.

There is broad support in the medical community for maintaining access to prescription controlled substances through telehealth. In November 2022the American Medical Association, the American Psychiatric Association, and more than 100 other health care organizations called on the DEA and Department of Justice to make this exemption permanent, and more than 370 health care organizations asked Congress in September to extend the waivers after the Public Health Emergency.

Congress must act now to preserve the ability of providers to prescribe controlled substances via telehealth to ensure that patients do not lose access to critical mental and behavioral health treatments when the pandemic ends.

David B. McKinley, PE has proudly represented the West Virginia 1st District since 2011. He currently serves as a Ranking Member of the Environmental Subcommittee in the House Committee on Energy and Commerce. McKinley has fought to preserve the health, safety and access to care of his West Virginia constituents and all Americans during the opioid crisis.

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