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September 10, 2024

Neera Tanden, J.D.

Director

U.S. Domestic Policy Council

The White House

1600 Pennsylvania Avenue NW

Washington, DC 20500

RE: Drug Enforcement Administration (DEA) Harming Patient Access to Critical Health Treatments

Dear Director Tanden,

We stand with you in improving access to mental health and substance abuse services across the country, and commend the Administration for making critical investments in access and treatment. It’s with our mutual commitment in mind that we write you today. Millions of Americans will lose access to critically important health care treatment on December 31, 2024 unless the Administration acts. We need your leadership to ensure that the Drug Enforcement Administration (DEA) preserves this access.

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 requires the DEA, in conjunction with the Secretary of HHS, to promulgate permanent rules to allow practitioners to prescribe certain controlled medications via telehealth through a special registration pathway. As of today, the agency still had not done so. In the advent of the Public Health Emergency, the DEA allowed DEA-registered practitioners to issue prescriptions for certain controlled substances to patients via telemedicine without requiring an in-person medical evaluation. These flexibilities have been a lifeline for countless individuals across the country, ensuring uninterrupted access to essential mental health care, substance use treatment, end-of-life care, and many other crucial treatments during a time when in-person visits were impossible or unsafe.

The ongoing challenges in accessing mental health and substance use treatment services, particularly in rural and underserved areas, underscore the importance of maintaining these flexibilities. More than half of U.S. counties do not have a psychiatrist. The shortage is even more prominent in rural areas, with nearly three quarters of rural counties lacking a psychiatrist. Telemedicine has proven to be an effective tool in bridging the gap between patients and providers, reducing barriers to care, and supporting those most in need. At its pandemic peak, telehealth represented 40% of mental health and substance use outpatient visits, and still remains strong, representing 36% of outpatient visits currently.

Given the widespread provider shortage across medical professions and specialties, this flexibility has been essential in ensuring that patients receive timely and necessary care. Continuing these practices is vital to sustaining access to treatment and addressing the ongoing healthcare challenges in underserved areas.

Given how late we are in the year and with the waiver expiring on December 31, there is very little time left for the DEA to release a draft rule for public comment, close the comment period, review the substantive feedback, and finalize the rule in time for the end of the year. Nearly 40,000 comments were submitted last year when the DEA first attempted to draft rules for a permanent framework on remote prescribing of controlled substances.

Given the success and positive clinical outcomes associated with the prescribing flexibility, the undersigned organizations request the Administration to work with the DEA and other relevant agencies to extend these prescribing flexibilities for two years while the DEA works to meet its congressional mandate to create a special registration pathway that continues access to care. An extension would avert patient harm from abruptly cut off care, while giving us all more time to come to consensus about the best way to balance access and enforcement.

Thank you for your consideration of this request. Please feel free to reach out to any signer of this letter for additional information and context.

Please see the attached PDF for the full list of organizational signatories.