DEA extends telemedicine flexibilities for controlled substances through December 2025

The Drug Enforcement Administration (DEA), in collaboration with the Department of Health and Human Services (HHS), has announced a third temporary extension of telemedicine flexibilities for prescribing controlled substances.

These rules, which have been in effect since the COVID-19 Public Health Emergency (PHE), will remain in place until December 31, 2025. This extension is designed to maintain access to essential medications, particularly for individuals in underserved and rural areas, as the DEA continues to evaluate long-term telemedicine regulations.

Background and evolution of telemedicine prescribing

The COVID-19 pandemic brought about significant changes in healthcare delivery, one of the most notable being the rapid expansion of telemedicine. As part of the efforts to reduce in-person visits and curb the spread of the virus, the DEA temporarily lifted certain restrictions on the prescribing of controlled substances via telemedicine.

Under these flexibilities, healthcare practitioners could prescribe Schedule II-V controlled substances through virtual consultations without requiring an in-person visit. This policy was especially crucial for individuals in rural areas and those who might otherwise face barriers to in-person care.

When the PHE ended in May 2023, the DEA faced pressure to either reinstate traditional in-person requirements or extend telemedicine flexibilities. The agency responded by issuing a series of temporary extensions, allowing healthcare providers to continue prescribing controlled substances via telemedicine. These extensions have been vital in ensuring continued access to healthcare services, particularly in mental health and addiction treatment.

One of the key provisions of these flexibilities allows practitioners to prescribe Schedule III-V narcotic medications used in the treatment of opioid use disorder (OUD) via audio-only telemedicine, further expanding access to critical care. This has been particularly important given the rise in opioid use and addiction, where maintaining consistent treatment is essential.

The DEA’s efforts to develop permanent rules

Despite the continued temporary extensions, the DEA has expressed its intent to develop a permanent set of regulations governing telemedicine prescribing. The process began in early 2023 when the agency introduced proposed rules that would have required in-person visits for most prescriptions after 30 days.

These proposed rules sparked a significant backlash from healthcare providers, patients, and advocacy groups, who argued that such requirements would disrupt access to care, particularly for vulnerable populations. The DEA received over 38,000 public comments and decided to extend temporary rules while considering feedback. The agency aims to balance continued access to telemedicine with addressing concerns about controlled substance misuse.

The DEA filed a Notice of Proposed Rulemaking with the White House Office of Management and Budget (OMB) in June 2024, indicating possible changes to prescribing practices influenced by public feedback and ongoing evaluations.

Stakeholder responses and concerns

The ongoing debate over telemedicine prescribing is shaped by the input of various stakeholders, including healthcare providers, patient advocacy groups, law enforcement, and policymakers. Each group brings a unique perspective to the issue, which influences the regulatory approach the DEA is likely to take.

Medical associations and healthcare providers

Medical organizations, such as the American Medical Association (AMA) and the American Telemedicine Association (ATA), have been vocal in advocating for the permanent continuation of telemedicine flexibilities. These groups emphasize that telemedicine has been instrumental in improving access to healthcare, especially in rural and underserved areas. For example, many patients who previously had to travel long distances for appointments can now access critical care from the comfort of their homes, making healthcare more convenient and timely.

For healthcare providers, the ability to prescribe controlled substances via telemedicine has streamlined care, particularly for patients who may not need an in-person visit. Telemedicine has also been crucial in managing chronic conditions, including mental health disorders, where continuity of care is vital. These organizations argue that returning to in-person requirements would disrupt the progress made during the PHE, potentially leading to gaps in care.

Patient advocacy and mental health groups

Patient advocacy groups, particularly those centered on mental health and substance use disorders, are pushing for the permanent extension of telemedicine flexibilities. They argue that telemedicine is vital for individuals with opioid use disorder, depression, and other conditions, particularly in rural or underserved areas where access to specialists and addiction treatment is limited.

For individuals seeking treatment for opioid use disorder, the ability to prescribe medications like buprenorphine via telemedicine has helped reduce barriers to treatment. The flexibility to conduct consultations via phone or video call has made it easier for patients to adhere to their treatment regimens without the need for frequent travel.

Law enforcement and diversion concerns

On the other side of the debate, law enforcement agencies have raised concerns about the potential for telemedicine to be exploited for the diversion of controlled substances. With the ability to prescribe medications without face-to-face interaction, some worry that individuals could fraudulently obtain prescriptions or that drugs could be distributed outside of the appropriate medical channels.

To address these concerns, the DEA and HHS have worked to implement safeguards, such as requiring certain telemedicine consultations to occur over video rather than audio-only calls, particularly for higher-risk medications. These regulations are part of the ongoing effort to balance the need for accessible healthcare with the need to prevent the misuse of controlled substances.

Likelihood of permanent flexibilities

As the DEA and HHS work toward finalizing the regulations, there is growing speculation about whether the current telemedicine flexibilities will become permanent. Many healthcare providers and patient advocacy groups are optimistic that the temporary rules will evolve into a more permanent solution, particularly given the clear benefits of telemedicine for improving access to care.

However, the DEA faces significant pressure to ensure that telemedicine prescribing does not contribute to the misuse of controlled substances. The agency must weigh the positive impacts of expanded access to treatment against the potential risks posed by telemedicine. As a result, the final regulations may involve a hybrid approach, allowing for continued telemedicine prescribing with additional safeguards and monitoring to prevent misuse.

The role of public comment and advocacy

One of the most significant aspects of the regulatory process has been the volume of public comment and advocacy. In 2023, more than 38,000 comments were submitted to the DEA, reflecting the strong interest and diverse opinions on this issue. This level of public engagement underscores the importance of involving stakeholders in shaping the future of telemedicine regulation.

As the DEA continues to review the feedback and consider potential changes, healthcare providers, patients, and advocacy groups must stay engaged. Monitoring developments and participating in public comment periods will be essential for influencing the direction of future regulations.

Preparing for the future of telemedicine

Healthcare providers should stay updated on evolving regulations and adjust workflows to ensure compliance with new prescribing guidelines. Legal teams should also evaluate the potential impact of stricter regulations and be ready to adapt.

The extension of current telemedicine flexibilities through December 2025 offers hope for continued access to care. By considering stakeholder input, the DEA and HHS can ensure telemedicine remains a crucial tool, especially for those needing treatment for mental health, addiction, and chronic conditions.

The DEA’s temporary extension for controlled substances, lasting through December 2025, ensures continued access to healthcare for millions. As the DEA works toward permanent regulations, it faces input from various stakeholders, each with a unique perspective. The future of telemedicine prescribing remains a key area of focus, with potential long-term impacts on healthcare delivery in the U.S.