The Georgia Medical Board restricts virtual prescriptions

Dr. Chair of the Boards. William Bostock told a reporter Thursday that such rules are important to protect Georgia citizens from dangerous drugs, requiring direct provider oversight to help prevent diversion (for illegal use) and unnecessary prescriptions.

Georgia’s board wrangled in meetings this week over how to clarify rules for the May 1 reopening.

Through May 1, Georgia patients and doctors will have flexibility for virtual prescriptions they hold under federal pandemic emergency declarations. On May 1, Georgia’s long-standing rules governing controlled substances will begin again, with additional announcements from the board to clarify what they mean.

Strict rules for prescribing controlled drugs like Ritalin or Adderall are nothing new. Georgia has had such rules since 2014. But for doctors and patients who have received telemedicine visits in place since the pandemic, the old rules weren’t clear enough on the details.

Pre-pandemic rules prohibited prescribing controlled substances based on contact via electronic means. Those rules say doctors can prescribe a dangerous drug to a patient following a valid doctor-patient relationship in accordance with the law. What is not understood in detail.

When the Georgia Medical Board in December suddenly reinstated its old rules effective Jan. 1, prescribers were left confused about what exactly the old rules allowed when it came to long-distance patients taking prescriptions that were renewed each month. Some doctors say they should stop seeing virtual patients for controlled drugs altogether until the board clarifies what is legal.

The board quickly retreated. It has delayed the ban until May 1 and is in the process of issuing clarifications to explain what will be allowed.

In Thursday’s discussion at the board’s meeting and in recent written statements, the board laid out some guidelines. It plans to issue more by May 1.

To begin with, opioids like oxycodone have different rules than other drugs like Ritalin, even though they are both controlled drugs.

For all controlled substances, the doctor writing the prescription must begin by visiting the patient in person, the board said in a written statement. The doctor must be licensed in Georgia, but the visit can be in or out of state, said Dr. Alexander Gross, chairman of the boards’ licensing committee.

After that, it depends on whether the drug is an opioid. Doctors who prescribe opioids for pain need to meet with the patient in person.

If the drug is not an opioid, such as Ritalin or Adderall to treat ADHD, after the first visit, virtual visits are fine, board members said. Instead, the board states that when a prescriber is renewing a prescription, he or she must make a diligent effort to have patients examined annually in person by a doctor, physician assistant or nurse practitioner licensed in Georgia. Advertisement

In a recent survey conducted by the American Psychiatric Association, 97% of responding psychiatrists said they now use telemedicine.

And the virtual prescription problem is huge in the South. Specialists are rare in rural Georgia, and telemedicine has allowed some to regularly see patients from distant counties and different states. The most recent state data showed that more than half of Georgia’s 159 counties, 90, lack a psychiatrist.

But the rules are meant to protect people from careless prescribing for profit. There has been an increase in drug addiction since the epidemic began. Additionally, there is a wave of private equity investment in virtual mental health practices, where good patient care may compete with investors’ financial goals.

The Georgia Composite Medical Board licenses and disciplines physicians practicing in the state. It can place a permanent stamp on their license if it detects unprofessional conduct or revoke the license altogether.

The federal government has its own restrictions on virtual prescribing, but they are still partially suspended under pandemic public health emergency powers. When the Biden administration lifted its emergency declarations, it noted the new popularity of virtual doctor visits, and the US Drug Enforcement Administration left that flexibility. The federal restrictions will be lifted until the end of 2024, with hopes that Congress will update the law this year.

Bostock said that in addition to the statements it has issued so far, the board hopes to issue an FAQ on the topic before May 1.

Eric Triana, chief compliance officer for remote mental health company Taciatry, said even the initial visit required for patients who can’t travel to the visit can serve as a deterrent. He said thousands of Georgia patients would be put off immediately.