2020-12-15 OMA Agenda - Board of Trustees

What are the practical considerations in initiating anti-obesity controlled substances (i.e., phentermine) via telehealth?

Historically, controlled substances could not be initiated in the US without an in-person encounter. Given the current declaration of a public health emergency due to COVID-19, the DEA has waived the need for an in-person visit prior to an initial prescription, provided that required two-way, real-time, audio-visual telehealth is used. (17) It is unclear how long this waiver will persist. Based upon a shared decision-making, clinicians should discuss (and document) with patients the potential risks and benefits of administering any type of obesity management via telehealth. (Table 1) After this patient-centered approach, after an evaluation of cardiovascular risk factors as listed in Table 2, and after general considerations in prescribing phentermine via telehealth as listed in Table 3, the patient and clinician should decide what path forward is in the best safety and medical interest of the patient. This may include prescribing phentermine. An illustrative example of a patient who may be appropriate for initial prescribing of phentermine via telehealth would be an established younger patient in the applicable medical practice, not at risk for pregnancy, without cardiovascular risk factors listed in Table 2, who meets the criteria in prescribing phentermine via telehealth as listed in Table 3, and who had taken phentermine in the past with demonstrable efficacy, safety, and tolerability.

After the COVID-19 has abated, obesity medicine specialists should consider when telehealth, face-to-face office visit, or a combination hybrid approach is in the best interest of the patient.

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