DEA Extends Telemedicine Flexibilities for Prescription of Controlled Medications
By Alisa Pierce

To avoid lapses in patient care now that the COVID-19 public health emergency (PHE) has ended, the Drug Enforcement Administration (DEA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary extension of telemedicine flexibilities for the prescribing of controlled medications originally adopted in March 2020. 

“The DEA received a record 38,000 comments on its proposed telemedicine rules. We take those comments seriously and are considering them carefully,” DEA Administrator Anne Milgram said in the announcement. “We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities for six months while we work to find a way forward to give Americans that access with appropriate safeguards.” 

During the pandemic, DEA granted temporary exceptions to the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which permitted physicians to prescribe controlled medications to a patient only after conducting an in-person evaluation of that patient. The exceptions allowed for such prescriptions via telemedicine even when the physician had not conducted an in-person visit with the patient. 

These flexibilities authorized physicians to prescribe Schedule II-V controlled medications through audio-video telemedicine encounters, including Schedule III-V narcotic-controlled medications approved by the Food and Drug Administration (FDA) for the maintenance and withdrawal management of opioid use disorder.  

As these waivers were set to expire with the PHE on May 11, DEA issued two proposed rules establishing new policies for controlled substance prescriptions based on telehealth visits, one for buprenorphine and one for other controlled substances.  

In response, the Texas Medical Association, among other medical organizations such as the American Medical Association and the American Hospital Association, weighed in on the policy through a pair of letters to DEA calling on the organization to consider “exclusions or exceptions for patients who may not be able to access a referring practitioner within the 30-day timeframe by allowing a six-month supply of medications to give additional time to schedule the physician exam.” 

After receiving what it said was “a record 38,000 comments on its proposed telemedicine rules,” DEA decided to extend the same policies that have been in place during COVID for an additional six months, until November 11, 2023.  

As a result, as of May 11, the temporary rule: 

  • Extends the full set of telemedicine flexibilities regarding prescription of controlled medications that were in place during the COVID-19 PHE for six months, through Nov. 11, 2023; 
  • For patient-physician telemedicine relationships established on or before Nov. 11, 2023, extends the full set of telemedicine flexibilities for one year, through Nov. 11, 2024. If a physician has established a telemedicine relationship with a patient on or before Nov. 11, 2023, the rule states, “the same telemedicine flexibilities that governed the relationship to that point are permitted until November 11, 2024;”  
  • Allows for prescribing a 30-day supply of buprenorphine to treat opioid use disorder without an in-person evaluation or referral. 

“DEA and SAMHSA agree that immediately ceasing the COVID–19 telemedicine flexibilities for relationships established both during and following the end of the COVID–19 PHE would jeopardize continuity of patient care,” the rule states. 

DEA said it plans to issue final regulations permitting the practice of telemedicine under circumstances “consistent with public health, safety, and effective controls against diversion.” 

Visit TMA’s Telemedicine and Prescribing web pages for information on telehealth and prescription changes after the PHE. TMA also offers an on-demand webinar answering member questions about how their practices will be affected at the end of the PHE. 

Last Updated On

May 12, 2023

Originally Published On

May 12, 2023

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Alisa Pierce

Reporter, Division of Communications and Marketing

(512) 370-1469
Alisa Pierce

Alisa Pierce is a reporter for Texas Medicine. After graduating from Texas State University, she worked in local news, covering state politics, public health, and education. Alongside her news writing, Alisa covered up-and-coming artists in Central Texas and abroad as a music journalist. As a Texas native, she enjoys capturing the landscape on her film camera while hiking her way across the Lonestar State.

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