How Telehealth Can Lead To Prescription Drug Abuse

The use of telehealth or telemedicine as a means of treating illness and other conditions surged during the pandemic, allowing Americans to be seen by a doctor without complications of exposure to COVID-19.

Since that time, a concern that telehealth may lead to prescription drug misuse has caused the government to implement new regulations regarding prescribing controlled substances.

Telehealth And Prescription Drug Abuse

Prescription drug misuse has been an issue for many Americans for over two decades now while aspects of telemedicine have been around for well over a century.

However, the expansion and accessibility of telemedicine have dramatically increased over the last several years, with the biggest development occurring during the COVID-19 public health emergency.

Increased accessibility, one of telehealth’s greatest strengths, has caused the practice of telemedicine to become an avenue for people to obtain and misuse prescriptions or have a substance use disorder (SUD) go undiagnosed.

Lack of accountability regarding drug-seeking behavior may actually lead to drug misuse.

Potential To Miss Signs Of Drug Abuse

One of the biggest ways telehealth services may lead to drug misuse is the lack of accountability.

A study by Quest Diagnostics found that most doctors (67% of those studied) worried that they were missing signs of opioid use disorder (OUD) and other prescription drug use disorders.

While telemedicine can show a patient on a screen, a doctor’s ability to read body language is compromised by the quality of the picture or the fact that it only shows the client’s face.

A study conducted during the pandemic by Quest Diagnostics found that most doctors (67% of those studied) worried they were missing signs of opioid use disorder via telehealth visits. While telehealth technology and clinical protocols have improved, the challenge of remote assessment remains relevant.

Ability To Conceal Location

People seeking multiple prescriptions may be able to do so by concealing or lying about their location during a telehealth visit.

This may enable them to connect with providers from out of the area or even out of state, expanding their ability to manipulate clinics for prescriptions.

Fool Doctors Through Acting

As is implied by doctors’ worry about missing signs of substance use disorder, people seeking controlled medications stand a greater chance in telemedicine of fooling doctors through acting.

Acting injured is one of the signs of opioid drug-seeking behavior. When a person comes into an office for an in-person visit, it is easier to observe flaws in the “act.”

However, during a telehealth visit, doctors observe patients for a limited amount of time. Also, without being able to observe body language cues, it’s easier for someone to convince a doctor of a false injury.

Telehealth And Data Sharing

A study in the Healthcare journal found that the lack of data sharing among clinics that offer telemedicine leaves the industry open to people who are manipulating it to further substance use.

The study noted that as long as there are clinics that don’t participate in data sharing, access to controlled substances will continue to be a problem.

Lack of data sharing may enable the following drug-seeking behaviors.

Doctor Shopping

Doctor shopping is one of the hallmark behaviors of people with an SUD involving prescription medications.

People who are facing prescription drug misuse will often go to many different doctors or clinics to get multiple prescriptions.

Doctor shopping is easier through telemedicine, if only because, on a practical level, it is easier to “shop” clinics from the comfort of your home.

Shopping for doctors is also made easier through the lack of adequate data sharing, hampering a clinic’s ability to discover where else the client has been in seeking care.

Use Of Multiple Pharmacies

Another hallmark of drug-seeking behavior includes the use of multiple pharmacies.

Without adequate data sharing, clinics may not be able to determine which pharmacies a person is using for refills or new prescriptions.

Forged Prescriptions

Forging prescriptions may also be easier, though telehealth’s vulnerability in this regard has surprising consequences.

According to mHealth Intelligence, four people (two of whom worked for a telehealth clinic) were charged with fraud in December 2021 due to convincing doctors to write prescriptions in exchange for kickback payments.

They were able to defraud insurance companies of around $37 million by convincing doctors that the “patients” they wrote prescriptions for had been seen by nurses. While substance abuse was not directly implicated in this incident, it demonstrates how vulnerable telehealth can be to manipulation.

Reinstating Regulations On Prescribing Controlled Substances

The DEA has established rules requiring in-person evaluations before prescribing certain controlled substances via telehealth. These regulations have continued to evolve since the COVID-19 pandemic and represent an ongoing effort to balance access to care with safeguards against misuse.

This rule requires people to meet a doctor in person before they can receive:

• OxyContin
• Vicodin
• Ritalin
• Adderall
• other opioid prescriptions

Requiring in-person consultations is a way to address potential addiction issues and gives doctors the chance to make appropriate evaluations.

The DEA is also reinstating prescribing rules for other mental and behavioral health medications. Healthcare providers can prescribe a 30-day initial dose of certain medications via telehealth for interventions but will need to conduct an in-person evaluation after that.

These medications include:

• Ambien (for sleep)
• codeine
• buprenorphine
• Xanax

Current Telehealth Prescribing Rules

The regulatory landscape for telehealth prescribing of controlled substances continues to evolve since the COVID-19 public health emergency ended.

The DEA implemented a framework that generally requires an in-person medical evaluation before prescribing controlled substances via telehealth, with limited exceptions for certain conditions and medications. Buprenorphine for opioid use disorder has received specific regulatory attention, with rules designed to balance access to treatment against diversion risk.

These rules are subject to ongoing revision. Patients and providers should consult the DEA’s current guidelines or speak with a healthcare provider for the most up-to-date information on telehealth prescribing in their state.

Positive Aspects Of Telehealth And Addiction Treatment

While lax rules during the pandemic may have led some to prescription drug misuse, there was also a positive side to telehealth and substance use disorder.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), addiction treatment and mental health facilities dramatically increased their use of telehealth services.

In 2015, about 26% of substance use disorder treatment facilities and 22% of mental health facilities used telemedicine to treat patients. In 2020, those percentages rose to almost 57% and 69%, respectively.

The benefits of telehealth medicine in addiction treatment are many.

Extends Treatment To Rural Areas

One of the biggest benefits of telemedicine in substance abuse treatment is that it gives people in rural areas access to treatment.

This is true throughout the United States, but the benefits of addiction treatment through telehealth services are especially felt in states with large rural areas. In some states, addiction treatment may be many miles away.

Rural states that benefit from telehealth include but aren’t limited to:

• Alaska
• North Dakota
• South Dakota
• Montana
• Wisconsin

Lowers Risk Of Overdose

According to the Centers for Disease Control and Prevention (CDC), a JAMA study of Medicare clients who attended opioid treatment programs through telehealth showed encouraging results.

Clients receiving telemedicine for opioid addiction treatment were found to have a 33% lower risk of a fatal drug overdose. Receiving medications such as buprenorphine or methadone in conjunction with treatment gave clients even less risk of overdose death.

Group Therapy

One of the concerns about virtual addiction treatment has been the inability of clinicians to conduct treatment in group settings.

With the improvement of technologies such as those enabled by Zoom, such services as group therapy or individual therapy are more effective in a telehealth context.

Stability Of Addiction Treatment At Home

Telehealth also gives clients the opportunity for increased privacy by providing treatment at home.

For people with addiction who have a stable home life, this form of addiction treatment can be very beneficial.

Some treatment centers use a modified version of telehealth, requiring visits for medications such as methadone and for drug testing, but allowing therapy to happen at home.

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Written by the Addiction Resource Editorial Staff