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Online Prescribing of Controlled Substances for Mental Health Issues: a View of the Current Landscape

  • Edward L. Kaftarian
  • Robert L. Caudill
  • Thomas Kim
  • Harish Lingam
  • Nina Antoniotti
  • Terry Rabinowitz
  • Kathleen Myers
  • Peter M. Yellowlees
  • Eve-Lynn Nelson
  • Sharon E. Cain
  • Shawna Wright
  • Donald M. HiltyEmail author
Article

Abstract

Controlled substances, such as benzodiazepines, narcotic pain medications, and stimulants, can be helpful in the treatment of a wide variety of mental and physical conditions. In order to limit the improper use and abuse of these medications, the state and federal governments regulate how controlled substances are prescribed, distributed, and dispensed. Telemedicine physicians are often reluctant to utilize controlled substances out of fear and uncertainty of the rules. This represents a barrier to the expansion of telemedicine practice and development of new systems within accountable care organizations, resulting in patients being deprived of opportunities to obtain appropriate treatments. This article briefly defines and reviews online prescribing, controlled substances (history, current practices), telehealth (general, videoconferencing), and legal/regulatory practices (state, federal). Cases are provided to informally stratify the prescribing landscape and risk into categories of low, medium, and high risk of prescribing and to illustrate cases in which prescribing would probably require a policy change. The policy landscape pertaining to the prescription of controlled substances via telemedicine is complex and confusing to many. This primer for clinicians, administrators, and health care administrators provides information and an approach to evaluate issues and make decisions. It is intended to encourage further discussion and advocacy for policies that facilitate, rather than inadvertently impede, appropriate prescription of controlled substances via telemedicine. Clinicians, professional organizations, and telehealth organizations need to collaborate with others to adjust policies to improve access. More research on clinical care (best practices, barriers/obstacles) related to online prescribing is needed and how online prescribing is working and/or not working (e.g., barriers are arising).

Keywords

Controlled substances Mental health Telehealth Prescribing Online Technology 

Notes

References

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Edward L. Kaftarian
    • 1
  • Robert L. Caudill
    • 2
  • Thomas Kim
    • 3
  • Harish Lingam
    • 4
  • Nina Antoniotti
    • 5
  • Terry Rabinowitz
    • 6
  • Kathleen Myers
    • 7
  • Peter M. Yellowlees
    • 8
  • Eve-Lynn Nelson
    • 9
  • Sharon E. Cain
    • 9
  • Shawna Wright
    • 10
  • Donald M. Hilty
    • 11
    Email author
  1. 1.Orbit Health Telepsychiatry, California Department of Corrections and RehabilitationEncinoUSA
  2. 2.Department of Psychiatry and Behavioral Sciences, University of LouisvilleLouisvilleUSA
  3. 3.LLC, Tulane University School of MedicineNew OrleansUSA
  4. 4.Business Development and Behavioral HealthLingam ConsultingLos AngelesUSA
  5. 5.Southern Illinois School of MedicineSpringfieldUSA
  6. 6.University of Vermont College of Medicine, University of Vermont Medical CenterBurlingtonUSA
  7. 7.University of Washington, Telemental Health Service, Seattle Children’s HospitalSeattleUSA
  8. 8.University of California, Davis School of Medicine and Health SystemSacramentoUSA
  9. 9.Telemedicine and Telehealth, Kansas City Medical CenterUniversity of Kansas School of MedicineKansas CityUSA
  10. 10.Kansas University Medical CenterKansas CityUSA
  11. 11.Northern California Veterans Administration Health Care System, Department of Psychiatry and Behavioral Sciences, UC Davis School of MedicineMatherUSA

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