On January 16, the U.S. Drug Enforcement Administration (DEA) announced three new telemedicine rules that extend prescribing flexibilities for controlled substances, following the expiration of temporary flexibilities granted during the COVID-19 pandemic. The new rules, which include both final and proposed regulations, aim to balance patient access with safeguards against misuse.
The rules apply only to patients are being prescribed controlled substances without ever having had an in-person visit with the prescribing provider. Once a patient has had an in-person medical evaluation, telemedicine prescribing remains unrestricted.
Expansion of Buprenorphine Treatment via Telemedicine Encounters (Final Rule)
This rule allows patients to receive an initial six-month supply of buprenorphine, a medication used to treat opioid use disorder, through a telemedicine consultation without requiring an in-person visit. After this initial period, however, patients must have an in-person evaluation with a medical provider before receiving further buprenorphine prescriptions.
Special Registrations for Telemedicine and Limited State Telemedicine Registrations (Proposed Rule)
The DEA has proposed a special registration process that would allow certain medical providers to prescribe controlled substances via telemedicine without ever conducting an in-person evaluation. Under this rule:
- Special registrations would be available for providers prescribing Schedule III-V controlled substances.
- An Advanced Telemedicine Prescribing Registration would be available for prescribing Schedule II medications (the most addictive and prone to misuse) but only for board-certified specialists in psychiatry, hospice care, long-term care, and pediatrics.
The DEA is seeking public comment on whether additional medical specialties should be included and whether additional safeguards should be implemented for Schedule II prescribing via telemedicine.
Additionally, this rule introduces new requirements for online telehealth platforms that connect patients with providers for prescriptions. Platforms facilitating these connections must register with the DEA.
A national Prescription Drug Monitoring Program will also be established to help healthcare providers track a patient’s controlled substance prescription history and prevent misuse.
Continuity of Care via Telemedicine for Veterans Affairs Patients (Final Rule)
The final rule specific to Veterans Affairs (VA) patients ensures that VA practitioners are exempt from the special registration requirements for telemedicine prescribing. Once a VA patient has had an in-person examination by any VA medical provider, he or she can receive controlled substance prescriptions via telemedicine from any other VA provider without additional in-person visits.
Looking Ahead
The DEA’s new rules reflect an effort to maintain the expanded access to telehealth prescribing that developed during the COVID-19 pandemic, while implementing safeguards against potential abuse. As telemedicine continues to evolve, these rules mark a significant step in shaping the future of remote prescribing for controlled substances.
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