The Future of Telehealth Prescribing for Controlled Substances: Extension or Evolution?
In response to the COVID-19 pandemic, the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS) introduced emergency flexibilities allowing the prescription of controlled substances via telehealth without an initial in-person visit. These temporary measures significantly expanded access to critical medications for patients across the United States, especially those in rural or underserved areas. On November 15, 2024, the DEA and HHS issued a third extension of these telehealth flexibilities, effective through December 31, 2025. While this extension ensures continuity of care for patients who have come to rely on virtual treatment options, it raises a central question for clinicians and policymakers alike: Will these flexibilities be extended again, or replaced with a permanent framework?
The third temporary rule reflects growing recognition that telehealth has become an essential component of modern healthcare. Telemedicine’s expansion during the pandemic was rapid and widespread, particularly in the mental health and substance use treatment fields. A study published in The Journal of Substance Abuse Treatment found that the relaxation of telehealth prescribing restrictions during the pandemic significantly improved treatment engagement and retention for patients receiving medications for opioid use disorder (MOUD) (Uscher-Pines et al., 2023). This underscores the public health benefit of maintaining access to controlled medications via telehealth platforms.
Another scholarly review in Psychiatric Services emphasized that telehealth-delivered psychiatric care, including the prescription of controlled medications such as stimulants and benzodiazepines, was not associated with increased rates of misuse or diversion when appropriate safeguards were in place (Liu et al., 2022). These findings challenge some of the traditional concerns around prescribing controlled substances remotely and provide an evidence-based rationale for continued telehealth prescribing under a regulated framework.
Still, the future of these flexibilities hinges on multiple factors. The DEA has proposed permanent rules that would allow for some forms of telemedicine prescribing, but with stricter requirements than those in place during the pandemic. For example, under the DEA’s proposed rule issued in 2023, a practitioner could prescribe a 30-day supply of certain controlled substances without an in-person exam, but would need to conduct one before authorizing refills. These rules were met with significant public and professional pushback, with over 38,000 comments submitted—many from healthcare providers urging the DEA to adopt a more flexible approach.
Given the volume and content of feedback, it is likely that the DEA will issue a revised final rule in 2025. That rule could become the foundation for a permanent policy governing telehealth prescribing. The agencies may also continue issuing temporary extensions to avoid disruption in care until a final rule is adopted. For now, the current extension through the end of 2025 provides critical time for providers and patients to adapt, and for policymakers to craft a data-driven, balanced regulatory approach.
In the broader context of U.S. healthcare, the push toward integrated, tech-enabled care is unlikely to reverse. Telehealth has become too vital—and too popular—to be relegated to emergency-only use. As such, the future of telehealth prescribing for controlled substances may not depend on another temporary extension but rather on the successful implementation of a thoughtful, permanent framework.
References
Liu, L., Lankton, E. A., Tia, B., Patel, R. P., & Reif, S. (2022). The Use of Telepsychiatry for Prescribing Controlled Substances: A Systematic Review. Psychiatric Services, 73(6), 672–681. https://doi.org/10.1176/appi.ps.202100567
Uscher-Pines, L., Sousa, J., Raja, P., Mehrotra, A., Barnett, M. L., & Huskamp, H. A. (2023). The Impact of Telehealth Flexibilities on Treatment for Opioid Use Disorder: Evidence from the COVID-19 Pandemic. Journal of Substance Abuse Treatment, 149, 108689. https://doi.org/10.1016/j.jsat.2023.108689