Telehealth Rules Complicate Opioid Access for Hospice, Palliative Patients During COVID-19

Drug Enforcement Agency (DEA) telemedicine rules are complicating hospice and palliative care patients’ access to necessary medications during the coronavirus pandemic. Some stakeholders have called on regulators to allow the use of audio-only telehealth for patient encounters that involve opioid prescriptions.

During the COVID-19 national emergency, the DEA has waived certain requirements to allow providers to prescribe controlled substances following a telehealth encounter without a prior in-person visit in a DEA-registered facility. However, the legal definition of telemedicine specifies audio-visual communication. This has caused problems among patients who lack the necessary devices, patients in rural areas, and those with limited internet access or none at all, according to a Health Affairs blog.

“We were trying to make a transition from traditional in-person visits to telemedicine visits, and one of the things that made that more difficult is that there were still some questions about whether we are allowed to legitimately prescribe medications to patients if we can’t establish video contact,” said Chad Kollas, M.D., palliative care physician at Orlando Health UF Health Cancer Center and co-author of the Health Affairs piece. “It has to do with how the regulations work with regard to prescribing controlled medications.”


Kollas is a member of the American Medical Association’s Opioid Task Force, which works to reduce opioid deaths in the United States and to educate the public about those medications. The task force has called on the DEA for more guidance on how to comply with opioid rules pertaining to opioid prescription via telemedicine.

While the U.S. Centers for Medicare & Medicaid Services has issued several 1135 waivers allowing providers to expand the use of audio-only telehealth for some services, at least temporarily, during the crisis. The DEA requirement seems to be holding fast to the audio-visual stipulation.

Close to a third of older adults live in solitude and 10% live in poverty, according to U.S. Census data cited in Health Affairs. Shelter-in-place orders have made it difficult for some families to obtain devices or secure home installations, and for many a telephone may be their sole connection to their health care providers for the time being.


Pain control is an essential component of both hospice and palliative care. A 2014 study found patients and families view pain and symptom management as their top priority related to quality of hospice care. Deficiencies in pain management can affect a hospice’s publicly reported quality and patient and family satisfaction scores, which prospective referral partners and patients are using increasingly when choosing a hospice.

“The coronavirus pandemic has made our practicing environment very unusual for many of us. We are also trying to figure out ways to accommodate people that were having difficulty getting their medications from the pharmacy or trying to connect with them via telemedicine when we didn’t have a way to do that visually, and then you only use a telephone,” Kollas told Hospice News. “Those were the challenges that we weren’t accustomed to doing. We are looking for guidance and looking for a temporary statement from the DEA that they will take this into account.”

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