Georgia medical board restores telehealth prescribing flexibility

Doctors who prescribe controlled substances like drugs with a risk of addiction can continue using telemedicine visits to do so. The board will provide more clarity by May 1.

The Georgia Composite Medical Board on Thursday restored doctors’ ability to prescribe controlled substances — which include painkillers and ADHD treatments — using just a virtual doctor visit. The board will clarify its rules and revisit the issue by May 1.

The move follows confusion and outcry from doctors, especially psychiatrists, after the board last month reimposed pre-pandemic restrictions on virtual prescribing, effective Jan. 1. The board had received several complaints from hospital systems and individuals about the reimposed restrictions.

“I emailed every one of my patients that was affected and some of them are really mad,” said Dr. Joseph Cubells, director of medical services at the Emory Autism Center. Cubells had spent hours New Year’s weekend updating prescriptions for those patients who have difficulty making it to an in-person visit. They live across the state. In light of the vague language in the rules, Cubells’ employers at Emory said they had no choice but to require an in-person visit for every prescription.

The board’s turnaround Thursday, Cubells said, is “awesome.”

Health professionals told the AJC in an article published Wednesday that the pre-pandemic rules were unclear and had the potential to harm patients’ access to care, especially those in rural areas.

Doctors came to rely on telemedicine visits as a key tool during the pandemic. That new access has become important since Georgia and the nation are facing a doctor and nurse shortage in rural areas, and especially in mental health. Ninety Georgia counties have no psychiatrist, as of the most recent data.

As part of pandemic emergency measures, the federal government loosened the rules on prescribing controlled drugs, easing prescribing for online patients. When the feds restored pre-pandemic health restrictions last year, they made an exception for virtual prescribing. They gave the practice an extension until December 2024 in hopes Congress and the Biden administration can craft new rules that will take account of the promise of virtual medicine, while also protecting the public from addiction risk and poor care.

Georgia’s Composite Medical Board decided to eliminate the telemedicine prescribing practice early.

The Board oversees Georgia’s doctors, and can punish unprofessional conduct by revoking a doctor’s license. Critics said the prescribing rule the Board reinstated Jan. 1 was not clear on exactly what was required to properly prescribe a controlled drug — whether a single in-person visit was needed before a prescription or if in-person visits were required more often.

Board members who spoke Thursday said they didn’t mean for it to be so restrictive. They added they would work in the coming weeks to add clearer language.

“(I’m) not an attorney but my read of the rules is all it’s going to require is that one visit,” said Dr. Matthew Norman, the lone psychiatrist on the board.

“I think that the medical profession in general got a black eye with over prescribing of opioids,” said Dr. Jeffrey Marshall, who chairs the board’s committee that investigates accusations of misconduct against doctors. I don’t think it’s too much to ask for the high quality of practice we expect in Georgia to have that one in person examination before prescribing opioids.”

The decisions come amid a surge in drug addiction since the pandemic began. In addition, there has been a wave of private equity investment in virtual mental health practices, where good patient care might compete with investors’ financial goals.