The Drug Enforcement Administration (DEA) is considering a rule that would end telemedicine prescriptions for controlled substances unless the patient has had an in-person appointment. Since testosterone is a Schedule III controlled substance, while estrogen is not, the rule could have a devastating impact on trans people who take that hormone, many of whom may not have options other than telehealth, especially as many states have moved to or already do restrict gender-affirming care.
Although the DEA initially proposed the rule changes in February, news of the rule recirculated this week, as the public comment period for the rule ends next Friday. If passed, the policy would require patients to have a face-to-face evaluation before being prescribed controlled substances via telemedicine, even though health care providers have been able to be prescribed such substances virtually since the onset of the COVID-19 pandemic. However, because the Biden administration has decided to terminate COVID-19’s designation as a public health emergency on May 11, the DEA proposed these rules to formalize certain telemedicine flexibilities that were established during the pandemic.
Providers will be able to virtually prescribe a 30-day supply of Schedule III-V non-narcotic medications without having seen a patient in person, but beyond that, patients would be required to have a face-to-face appointment. Patients would have the option to see a DEA-registered practitioner who could then write a referral for telehealth. The rule, however, will not affect people who have previously seen their providers in person but now use telehealth to be prescribed controlled substances by that same doctor.
The DEA estimated that 67,458 patients annually will be affected by this rule change. While there are no statistics on how many trans people are prescribed testosterone through telehealth and have never seen their provider in person before, that population will likely make up a large portion of those affected by the rule change, since testosterone is a Schedule III controlled substance. People with opioid use disorder will also be affected, since the rule would limit the availability of buprenorphine, a medication used to treat opioid use disorder. (It’s worth noting that some research indicates that trans people are at an elevated risk for substance use disorders in general.)
Medical professionals and activists alike have decried the rule change. Trans activist Cecilia Gentili posted on Instagram to raise awareness about the rule, and the need for public comments, alongside the caption “DO SOMETHING TO PROTECT TRANS HEALTHCARE TODAY!”
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Addiction medicine physician Dr. Kim Sue added her personal experience initiating patients with opioid use disorder onto buprenorphine without any in person visits. She added that for rural patients, and people with transportation issues, “this is a major barrier to life-saving meds.” The same is, of course, true of rural trans people, disabled trans people, low-income trans people, and trans people with transportation issues.
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Senators Ed Markey and Elizabeth Warren have previously called for the descheduling of testosterone. “There’s clearly efforts that are percolating all across the country. And so I think it’s important for the federal government to stand up,” Markey told The 19th. “Classifying testosterone as a Schedule III drug means that trans people face unnecessary and burdensome restrictions.”
The rule change is open for public comment until next Friday, and you can submit comments here.
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