DEA, HHS Issue Third Extension of Pandemic Telehealth Prescribing Flexibilities

In November the Drug Enforcement Administration (DEA) in concert with the U.S. Department of Health and Human Services (HHS) issued a third extension of COVID-19 telehealth flexibilities for the prescribing of controlled medications, to be effective through December 31, 2025.

These telemedicine flexibilities, originally granted in March 2020 as part of the COVID-19 Public Health Emergency, authorize qualified health professionals to prescribe Schedule II-V controlled medications via telemedicine, including Schedule III-V narcotic-controlled medications approved by the Food and Drug Administration for the treatment of opioid use disorder via audio-only telemedicine encounters.

“This additional time will allow DEA (and also HHS, for rules that must be issued jointly) to promulgate proposed and final regulations that are consistent with public health and safety, and that also effectively mitigate the risk of possible diversion,” the extension states. “Furthermore, this Third Temporary Rule will allow adequate time for providers to come into compliance with any new standards or safeguards eventually adopted in a final set of regulations.”

According to information leaked to reporters last September, the DEA had initially proposed several restrictions in their draft rule, such as limiting providers to do 50% of controlled substance prescribing online and requiring providers to check every state’s prescription drug monitoring program before prescribing a controlled substance to a patient they haven’t seen in person. The proposals received blowback from 11 Senators when they were revealed.

“It is a relief that the DEA has extended the status-quo for another year,” Lief Fenno, M.D., Ph.D., chair of the APA Council on Addiction Psychiatry told Psychiatric News. “Allowing telehealth flexibilities to expire would have introduced unnecessary chaos into the substance use treatment ecosystem and, on such short notice, would have had the real potential to harm patients.”

Fenno added that clear expectations of the regulatory structures governing care provision are necessary for health professionals and care systems to invest time and resources in developing substance use treatment programs.

“At the same time, we know that barriers to treatment reduce patient access to life-saving interventions, such as buprenorphine,” Fenno said. “Other federal agencies addressed this same issue by issuing permanent rules to support telehealth treatment of opioid use disorder nearly a year ago, and the DEA should both coordinate with these other agencies to reduce the potential for conflicting regulations and issue their own permanent rule. This is especially important in the current era of sky-high opioid-related mortality.”

The DEA had proposed regulations that would curtail some telemedicine prescribing flexibilities extended to qualified health professionals during COVID-19 back in 2023 as well—for instance, by requiring an in-person visit for the prescribing of controlled substances. (The proposals appeared as two separate rules in the Federal Register: “Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation” and “Expansion of Induction of Buprenorphine Via Telemedicine Encounter.”)

APA filed two letters in response to these proposed rules in March 2023, urging that the DEA balance common-sense safeguards for DEA enforcement without decreasing access to lifesaving treatment. In October 2023, the DEA and HHS issued a second temporary extension that continued the telehealth flexibilities until December 31, 2024. ■