Starting May 1, the Georgia Composite Medical Board will reinstate a pre-pandemic ban on using only virtual patient visits to prescribe controlled drugs — prescriptions that can be dangerous or prone to addiction.
For those drugs, patients will have to return to in-person visits either part or all of the time, depending on the type of drug.
The board, composed mostly of doctors, is trying to balance patient safety with the new widespread popularity of virtual prescribing, especially in specialties like psychiatry where doctors are scarce.
Dr. William Bostock, the board’s chair, told a reporter Thursday that such rules are important “To protect the citizens of Georgia from dangerous medication which requires direct provider supervision to help prevent diversion (for illegal use) and unnecessary prescribing.”
The Georgia board has been wrangling in meetings this week with how to clarify the rules that resume May 1.
Until May 1, Georgia patients and doctors will continue to have the flexibility for virtual prescribing that they’ve had under the federal pandemic emergency declarations. On May 1, Georgia’s longstanding rules restricting controlled substances will resume, with added statements from the board to clarify what they mean.
Strict rules for prescribing controlled drugs like Ritalin or Adderall are nothing new. Georgia has had such rules since 2014. But for doctors and patients who’ve taken up telemedecine visits in force since the pandemic, the old rules were no longer clear enough on the details.
The pre-pandemic rules ban the prescribing of the controlled substances “based solely on a consultation via electronic means.” Those rules say that doctors can prescribe “a dangerous drug for a patient pursuant to a valid physician-patient relationship in accordance with” the law. What that meant in detail was not spelled out.
When the Georgia medical board in December suddenly reimposed its old rules effective Jan. 1, prescribers erupted in confusion over what exactly the old rules allowed when it comes to distant patients who take prescriptions that might renew every month. Some doctors said they would have to stop seeing virtual patients for controlled drugs altogether until the board clarified what was legal.
The board quickly relented. It delayed the ban until May 1, and is in the process of issuing clarifying statements to explain what is and isn’t allowed.
In discussion at the board’s meeting Thursday, and in recent written statements, the board has laid out some guidelines. It plans to issue more before May 1.
To start with, opioids like oxycodone will have different rules than other drugs like Ritalin, even though they’re both controlled drugs.
For all controlled substances, the doctor writing the prescription must start with an in-person visit with the patient, the board said in a written statement. The doctor must be licensed in Georgia, but the visit can take place in or outside of the state, said Dr. Alexander Gross, chairman of the board’s licensure committee.
After that, it depends whether the drug is an opioid or not. Doctors prescribing opioids for pain will have to keep meeting the patient in person.
But if the drug is not an opioid, but rather something like Ritalin or Adderall to treat ADHD, after that first visit, virtual visits are fine, board members said. Instead, as the prescriber renews the prescription, he or she “must make diligent efforts to ensure” that patients are examined once a year in-person, by a doctor, physician assistant, or nurse practitioner who is licensed in Georgia, the board said in a statement.
In a recent survey by the American Psychiatric Association, 97% of psychiatrists who responded said they now use telemedicine.
And the issue of virtual prescribing is a huge one in the South. Specialists are rare in rural Georgia and telemedicine has allowed some to see patients regularly from distant counties and even different states. The most recent state data showed more than half of Georgia’s 159 counties — 90 — had no psychiatrist.
But the rules are meant to protect the public from careless prescribing for profit. There’s been 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.
The Georgia Composite Medical Board licenses and disciplines physicians who work in the state. It can put a permanent mark on their license if it finds unprofessional conduct, or revoke the license altogether.
The federal government has its own restrictions on virtual prescribing, but those are still partly suspended under pandemic public health emergency powers. When the Biden administration was lifting its emergency declarations, it recognized the new popularity of virtual doctor visits, and the U.S. Drug Enforcement Administration left that flexibility in place. The federal restrictions will remain lifted until the end of 2024 in hopes Congress will update the law this year.
Bostock said In addition to the statements it has issued so far, the board intends to issue an FAQ on the subject before May 1.
Eric Triana, chief compliance officer of the remote mental health company Talkiatry, said even the single required initial visit would serve as a barrier to patients who can’t travel to the visit. “Thousands of Georgia patients would be immediately cut off,” he said.
