DEA Proposes Limits on Telehealth Prescriptions of Controlled Substances 

The US Drug Enforcement Administration (DEA) has released proposed rules governing telehealth-based prescribing that extend some telehealth flexibilities but reinstate previous rules related to the virtual prescription of some controlled substances following the COVID-19 public health emergency (PHE).

At the beginning of the COVID-19 pandemic, various policy changes led to a higher level of leniency in the rules surrounding prescriptions provided via telehealth. This was mainly due to the need to limit exposure to the deadly coronavirus. However, as the PHE evolved and vaccines and treatments became more widely available, the government is revisiting policy flexibilities related to telehealth.

In this proposal from the DEA, the agency noted that various pandemic-era telehealth rules would be made permanent. These include telehealth consultations that do not involve prescribing controlled medications and those that do but are conducted by a medical practitioner that has previously performed an in-person examination of the patient.

Further, the rules would allow telehealth consultations and prescriptions by providers to whom a patient has been referred if the referring provider has previously conducted an in-person patient exam.

In some cases, the DEA will also safeguard telehealth consultations by a medical practitioner that result in controlled medication prescriptions without any in-person patient evaluation. This flexibility would only extend to telehealth prescriptions of a 30-day supply of Schedule III-V non-narcotic controlled medications and a 30-day supply of buprenorphine for the treatment of opioid use disorder (OUD).

Provided the prescription complies with federal and state laws, the above controlled substances can be prescribed via telehealth without an in-person evaluation or a referral from a medical practitioner that has conducted an in-person evaluation.

“DEA is committed to ensuring that all Americans can access needed medications,” said DEA Administrator Anne Milgram in a press release.  “The permanent expansion of telemedicine flexibilities would continue greater access to care for patients across the country, while ensuring the safety of patients. DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm.”

The agency's proposed rules do not extend to other controlled substances, like Adderall, Oxycodone, Vicodin, and Ritalin, however, leading the American Telemedicine Association (ATA) and the ATA Action, its advocacy arm, to express concerns that the rules are too restrictive.

“The proposed rules from the DEA are significantly more restrictive than is warranted. Our concern lies with the potential public health crisis this could cause for individuals needing access to clinically appropriate prescriptions of controlled substances for a wide variety of medical circumstances, including for mental health and substance use disorders. The continuity of care for countless Americans will be severed, potentially leaving these patients to fall through the cracks of our healthcare system without access to needed medications,” said Kyle Zebley, the ATA’s senior vice president, public policy, and executive director, ATA Action, in a press release.

But despite some proposed restrictions, the DEA's proposed rules would allow for continued virtual access to buprenorphine, a drug for OUD treatment. This aligns with other federal agency moves to incorporate virtual care into the response to the OUD crisis.

In December 2022, the US Department of Health and Human Services (HHS) proposed updates to federal regulations that would allow for the use of telehealth to treat OUD.

The proposed rule changes would update federal regulations that encompass OUD treatment standards as part of the HHS Overdose Prevention Strategy, including allowing providers to initiate buprenorphine prescriptions using telehealth as part of opioid treatment programs.