For patients who are bed-ridden or in the final days of their life, it may be next to impossible for a hospice and palliative care physician to conduct an in-person evaluation to satisfy state and federal rules for prescribing controlled substances. While the authors of a new commentary in Health Affairs acknowledge that the U.S. Drug Enforcement Administration (DEA) have helped ease the burdens for patients with chronic pain, hospice and palliative care patients remain an extremely vulnerable population with distinct needs.

The challenge is not only the ability to prescribe to patients who are bedbound or approaching the end of their lives, according to the authors, but any patient with symptoms and needs for whom a prescription of a controlled substance is indicated. For example, if a patient is living with metastatic cancer and requires opioid analgesics for the pain, unless the physician has previously seen the patient, even with DEA’s new flexibility, the patient will not be able to prescribe it for the patient, including if the patient goes into a hospice program.

“We call on the DEA to waive the visual requirement for telemedicine visits  so that during the pandemic,  palliative care providers  can prescribe controlled substances to patients who have not previously been seen in person or via telemedicine in DEA facilities and who do not have visual telemedicine options. If this waiver is granted, we will be able to provide the full range of palliative care treatment needed to reduce hospitalizations, decrease exposure to COVID-19, significantly reduce suffering, and save lives.”

“If this waiver is granted, we will be able to provide the full range of palliative care treatment needed to reduce hospitalizations, decrease exposure to COVID-19, significantly reduce suffering, and save lives,” write Patrice Villars, MS, GNP-BC, Eric Widera, MD, and Chad Kollas, MD.

Currently, for the duration of the pandemic, the DEA has allowed audio-visual evaluations of patients to be able to prescribe controlled substances. Audio-only can be used for existing patients.

In an interview, the authors also acknowledged that even if the DEA changes its rules, it is incumbent upon governors to adopt those rules.

“Even if the DEA provides further flexibility for hospice patients, there are too many states where current laws, payer and pharmacy policies would prevent us from helping our patients,” said Dr. Kollas. “This is why it’s essential for governors to follow the DEA.”