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Another Controlled Substance Prohibition in Telemedicine

Wednesday, February 1, 2017  
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Another Controlled Substance Prohibition in Telemedicine

Published onJanuary 13, 2017

DonnaVanderpool, MBA, JD

VP, Risk Management at PRMS, Specialists in Professional Liability Insurance Programs


Michigan recently enacted a very shorttelehealth law. In addition to definitions, the law has two substantive provisions, an informed consent requirement and a prohibition on prescribing controlled substances.

As with other areas of telemedicine, there is a lack of consistency among regulators. Under federal law, specifically the Controlled Substances Act, controlled substances currently can be prescribed only after an in-person visit with the patient. (For the very limited exceptions, see myprior post.)While some states, like Michigan, seem to have a flat out ban on prescribing controlled substances via telemedicine, other states follow the federal law. For example, the Rhode Island regulators addressed the issue this way in itsGuidance: “The BMLD [Board of Medical Licensure and Discipline] specifically highlights that prescribing controlled substances without an established in-person physician-patient relationship is prohibited.” (The guidance notes, consistent with federal law, there are exceptions for covering physicians.) Other states address the issue differently. For example, underFlorida law, “Controlled substances shall not be prescribed through the use of telemedicine except for the treatment of psychiatric disorder…”

Take away point:Since services are considered rendered in the state where the patient is physically located, the telemedicine physician has to ensure compliance not only with the laws of her state, but also the laws of the patient’s state (if different). It may be difficult to understand what exactly those requirements are since there is pervasive inconsistency between states and we do not yet have much enforcement or interpretive guidance. But by being proactive, you’ll be taking steps to ensure the appropriate use of telemedicine in your practice.


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