In a jolt to doctors who prescribe some controlled drugs that may be dangerous or habit-forming, the Georgia Composite Medical Board has restored pre-pandemic restrictions on doctors who prescribe controlled substances without an in-person visit.
The change took effect Jan. 1. Doctors and patients who have come to rely on telehealth or virtual doctor visits conducted by video are now scrambling to understand and comply with the law.
The board voted Dec. 7 to make the change, giving medical offices less than a month to adjust. The Composite Medical Board oversees doctors in Georgia, and if it finds unprofessional conduct it can put a permanent disciplinary mark on a doctor’s license, or revoke their license to practice in the state altogether.
During the federal pandemic emergency, many federal rules and restrictions concerning health care were suspended. As the emergency provisions have ended one by one, most of those rules have gone back into place. But in a nod to the new popularity of virtual health care, the federal government extended the ability to prescribe more drugs without an in-person visit to the doctor’s office. Washington now has another year, until December 2024, to adapt new federal rules to the changed virtual landscape in a way that will still protect the public health.
Georgia’s medical board decided not to wait.
In response to questions from The Atlanta Journal-Constitution for this article, the director of the Georgia Composite Medical Board said the board discussed the federal government’s delay in a number of its meetings. The vote to restore the Georgia restrictions now was unanimous, he said. There is one psychiatrist on the 16-member board, and he seconded the motion.
Some local doctors who are affected said they were blindsided by the change and that it wasn’t clear if they have to see the patient in-person each time a prescription needs to be renewed.
That would be a big barrier to health care for some patients, said Dr. Joseph Cubells, a psychiatrist at Emory Healthcare whose patients often have disabilities. Some of his patients are nonverbal, others may act out if they have to get in a car, and others live up to three hours away from his office.
Cubells said he thought it would be reasonable to require him to see a patient in person occasionally, for example once a year. “I see people from all over the state,” Cubells said. “To ask people to drive three hours to pick up a prescription, just to get a prescription, seems just insane to me.”
The state medical board’s director, Daniel Dorsey, told the AJC in a written statement “the GCMB’s decision does not forbid tele-prescribing.” For further understanding he said doctors could read the law and the board rules.
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.
Cubells said Emory has asked the board for clarification on the new rule, but they don’t have clarification yet.
Janet Christenbury, a spokeswoman for Emory Healthcare, said in a written statement that Emory had learned of the medical board’s decision around the time of the vote. “We feel this new approach to prescribing controlled substances negatively affects many patients in addition to our psychiatry team, who have been able to achieve better access to health care and compliance by patients using telemedicine capabilities.”
The new rule comes 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.
Cubells has a rare specialty in Georgia, treating adults with autism spectrum disorder and other neurodevelopmental disabilities. But even among more common specialties, health care is sparse. Ninety Georgia counties had no psychiatrist at all, according to the Georgia Board of Health Care Workforce, as of the latest data available, in 2020.
The old pre-pandemic prescribing rules might make sense for a surgeon or a pain doctor, Cubells said. In a survey in April and May of 2023, 97% of psychiatrists surveyed said they now conduct telemedicine visits, according to the American Psychiatric Association.
That study was submitted in testimony to the federal government as the pre-pandemic ban was up for renewal. The Drug Enforcement Administration held a listening session to hear evidence and perspectives from communities that might be affected by the ban.
In Georgia, it’s not clear whether that happened.
Laurisa Guerrero, executive director of the Georgia Council for Recovery, said that as far as she and her colleagues could tell, the Georgia board didn’t solicit comment from the addiction recovery community. Guerrero said she only learned of the board’s action when a reporter asked her about it Tuesday.
Guerrero is concerned by the move, she said. People in addiction recovery need stable access to doctors, and especially in rural communities that is often hard to come by. For example, she said, a patient may need Adderall — which is widely prescribed for attention deficit disorders — and if they can’t get it, they may turn to illegal drugs and self-medicate.
”By making it where people can’t use telehealth options, it has a bigger impact in rural communities than, say, it would in Metro communities,” she said. “Transportation is one of the biggest barriers in rural communities. They don’t even have Uber ... It’s just a huge barrier.”
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