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Prescribing During the Pandemic

The COVID-19 pandemic has disrupted the delivery of care across the country, including for patients receiving chronic pain medications and medication-assisted treatment (MAT) for substance use disorder. To minimize these disruptions, federal agencies have made important exceptions to standard prescribing regulations, as outlined in a previous blog.

One of these important exceptions is for new patients receiving chronic pain medication, who would normally require an in-person visit before any telemedicine prescribing was allowed. That has changed, with new guidelines allowing initial visits to take place remotely. “As long as this Public Health Emergency remains in effect,” said Quest Senior Medical Advisor, Dr Jeff Gudin, “all Drug Enforcement Agency–registered physicians can issue prescriptions for Schedules 2 through 5 controlled substances, for patients for whom they have not provided an in-person medical evaluation, provided that the prescription is issued for a legitimate medical purpose within the scope of your usual practice, the telemedicine visit is via a 2-way audiovisual real-time communication link, and all state and federal laws are observed.”

Medication-assisted treatment with buprenorphine or methadone has been valuable for many patients with substance use disorders. Normally, an initial in-person evaluation is required before commencing treatment. The Substance Abuse and Mental Health Services Administration (SAMHSA) has granted exemptions to opioid treatment programs (OTPs) to allow initial evaluation remotely for the prescription of buprenorphine, but not for methadone, because the dose escalation that is prescribed at the start of methadone treatment is not appropriate for take-home treatment, the agency said.1

Treatment for patients receiving ongoing MAT also poses special challenges, because in most cases in normal times, patients travel to a treatment center to receive their medication. During the pandemic, this may not be advisable or even possible. “In the event the patient is quarantined, alternative delivery methods are allowed, including doorstep delivery of take-home medications such as methadone,” Dr Gudin said.

SAMHSA has also developed guidance for opioid treatment programs for issues of medication delivery.2 If the patient cannot come to the treatment center, an uninfected member of the family may pick up prescribed medications in their place. If such a person is not available, the treatment program should prepare a doorstep delivery of medication within an approved lock box. Steps must be taken to ensure the patient receives the medication, and provides proper identification, while program personnel remain at least 6 feet away during delivery confirmation.

“Even if you are prescribing virtually, it is still a good idea to monitor your patients’ medication compliance,” Dr Gudin said. Patients can go to any one of thousands of Quest testing centers around the country and be safely and conveniently tested.

Published date: Oct. 21, 2020

1. Substance Abuse and Mental Health Services Administration (SAMHSA). FAQs: Provision of methadone and buprenorphine for the treatment of Opioid Use Disorder in the COVID-19 emergency. April 21, 2020. Accessed July 27, 2020.

2. Substance Abuse and Mental Health Services Administration (SAMHSA). OTP guidance for patients quarantined at home with the coronavirus. March 30, 2020. Accessed July 27, 2020.