How to Prescribe Controlled Substances Under COVID-19 Waivers
By David Doolittle


If you treat patients with chronic pain, you can temporarily prescribe certain controlled substances during a telemedicine visit under state and federal waivers issued in response to the COVID-19 pandemic.

On July 1, the Texas Medical Board (TMB) announced it will extend its emergency rule allowing telephone refills of valid prescriptions for treatment of chronic pain by a physician with an established chronic pain patient. Also, a physician still may use telemedicine medical services to treat a chronic pain patient with scheduled drugs as otherwise allowed by federal and state law.

The emergency rule requires that physicians consider certain factors before prescribing those medications during a telemedicine visit, “including the date of the patient’s last in-person visit, patient co-morbidities, and occupational-related COVID-19 risks.”

In addition to normal documentation requirements, physicians also must document in the patient’s medical record why the visit took place via telemedicine rather than in person, as well as which exception the physician is relying on to justify the telemedicine medical treatment, either the COVID-19 pandemic or as “otherwise allowed by federal and state law.”

The emergency rule extension goes into effect July 5 and expires Sept. 2 at 11:59 pm or when Gov. Greg Abbott’s March 13 disaster declaration ends, whichever is sooner.

TMB updated its COVID-19 Telemedicine FAQ on July 1 with additional guidance for reference.

Meanwhile, the U.S. Drug Enforcement Administration (DEA) says it will allow DEA-registered physicians to issue prescriptions for all schedule II-V controlled substances via telemedicine for patients for whom they have not first conducted an in-person medical evaluation as long as all of the following conditions are met:

  • The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice;
  • The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system;
  • The practitioner is acting in accordance with applicable federal and state laws; and
  • The Secretary of Health and Human Services’ designation of a public health emergency remains in effect. 

The agency also released guidance on other limitations and requirements applicable to issuing prescriptions via telemedicine for controlled substances, such as guidance on refills, issuing oral prescriptions for schedule II controlled substances, and whether a telephone medical evaluation is permissible before prescribing buphrenorphine to a patient to treat opioid use disorder.

The agency provides a helpful flowchart to navigate some of its waivers and exceptions for issuing prescriptions or refills for controlled substances.

Subject to meeting state and federal requirements, prescriptions can be issued using any of the methods of prescribing currently available, including electronically (for schedules II-V), or by calling in an emergency schedule II prescription to the pharmacy, or by calling in a schedule III-V prescription to the pharmacy.

As a reminder, Texas physicians must check the patient’s history on the state’s prescription monitoring program, known as PMP Aware, before dispensing or prescribing opioids, benzodiazepines, barbiturates, or carisoprodol.

Find more information about telemedicine, including updates related to COVID-19, on the TMA Telemedicine Resources webpage.

For the latest news and information on the coronavirus pandemic in Texas, including links to official Centers for Disease Control and Prevention, Texas Department of State Health Services, and TMB documents, be sure to visit the TMA COVID-19 Resource Center regularly.


Last Updated On

August 19, 2020

Originally Published On

March 24, 2020