Connecticut has taken another step towards expanding the meaningful use of telemedicine in connection with treatment of mental health and substance use disorders. SB 302, signed by Governor Dannel Malloy and effective July 1, 2018, allows providers to prescribe controlled substances via telemedicine for the treatment of psychiatric disabilities or substance use disorder, including medication assisted therapy. The law reverses Connecticut’s prior per se ban on prescribing Schedule I, II, or II controlled substances via telehealth technologies.
The law is a huge benefit for Connecticut patients with mental health or substance use disorder issues, allowing these individuals to obtain better access to quality care. Industry advocates have applauded the Legislature and Governor for this change. Connecticut’s telepsychiatry and substance abuse treatment providers can now incorporate controlled substances into their therapies, which is an important and clinically significant component of these specialties.
The Connecticut Psychiatric Society led the charge to help make this new law a reality. “We are in the midst of a national opioid crisis, yet Connecticut physicians were barred from prescribing needed treatments for opioid addiction during a telepsychiatry appointment,” said Melissa Welby, M.D., Immediate Past President of the Connecticut Psychiatric Society. “We are happy and grateful the Legislature agreed the law needed to change. Now, patients throughout Connecticut – including those living in regions with shortages of local psychiatrists and addiction medicine specialists – will enjoy better access to quality psychiatric care because of telemedicine.”
Disclosure: attorneys in Foley’s Telemedicine Industry Team worked with the Connecticut Psychiatric Society to draft the legislative language in SB 302 allowing telemedicine prescribing of controlled substances in Connecticut.
What Does the Connecticut Controlled Substance Telemedicine Prescribing Law Do?
In short, the new law allows a Connecticut telehealth provider to prescribe Schedule II and III controlled substances via telemedicine to treat patients with a psychiatric disability or substance use disorder, including medication assisted therapy. Opioid prescribing is not allowed. The law requires the telehealth provider to use electronic prescribing when submitting/transmitting the prescription.
The relevant statutory language states as follows:
Notwithstanding the provisions of this section or title 20, no telehealth provider shall prescribe any schedule I, II or III controlled substance through the use of telehealth, except a schedule II or III controlled substance other than an opioid drug, as defined in section 20-14o, in a manner fully consistent with the Ryan Haight Online Pharmacy Consumer Protection Act, 21 USC 829(e), as amended from time to time, for the treatment of a person with a psychiatric disability or substance use disorder, as defined in section 17a-458, including, but not limited to, medication-assisted treatment. A telehealth provider using telehealth to prescribe a schedule II or III controlled substance pursuant to this subsection shall electronically submit the prescription pursuant to section 21a-249, as amended by this act.
The term medication-assisted treatment means “the use of medications approved by the federal Food and Drug Administration, in combination with counseling and behavioral therapies, to provide a whole-patient approach to the treatment of substance use disorders.”
What About Federal Laws?
Providers should continue to be mindful of prescribing requirements under federal laws, as telemedicine prescribing of controlled substances is also governed by the Ryan Haight Act. Among other things, the Ryan Haight Act requires a threshold in-person examination between the prescriber and the patient, although there are seven exceptions for the practice of telemedicine.
Connecticut law must be read in harmony with the Ryan Haight Act requirements, and a prescriber must comply with both Connecticut and federal laws in this regard. Providers must understand and navigate many intersecting state and federal laws on telemedicine, medical practice, fraud and abuse, and controlled substances.
What’s Next for Telemedicine?
The new law follows a growing trend among states to amend and eliminate prior statutory prohibitions on telemedicine prescribing of controlled substances, particularly in light of the goal of supporting the availability of alternative therapies to address the opioid crisis. The U.S. Congress is also taking action to allow greater telemedicine prescribing of controlled substances. Connecticut now joins a growing number of other states (e.g., Delaware, Florida, Indiana, Michigan, New Hampshire, Ohio, West Virginia) that have recently enacted laws expressly allowing telemedicine prescribing of controlled substances.
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