The landscape of telemedicine in the United States is undergoing a profound transformation. On January 16, 2025, the Drug Enforcement Administration (DEA) unveiled a series of regulatory changes designed to expand and solidify telemedicine practices.[i] These changes aim to increase access to care, ensure continuity of treatment and provide permanent frameworks for prescribing controlled substances remotely.

The DEA’s announcement introduced final and proposed rules to make permanent many of the telemedicine flexibilities initially established during the COVID-19 pandemic. These flexibilities will allow healthcare providers to remotely prescribe controlled substances, ensuring that patients, especially those in underserved areas, can access essential care without the need for in-person visits. The rules strike a balance between maintaining open access to telehealth services, while implementing safeguards to prevent overprescribing and misuse of controlled substances.

Expansion of buprenorphine treatment via telemedicine encounters

Among the finalized rules, one stands out for its potential to address the persisting opioid crisis with the expansion of buprenorphine treatment via telemedicine.[ii] This regulation allows practitioners to prescribe buprenorphine and other Schedule III-V narcotics for opioid use disorder (OUD) through telemedicine encounters, including audio-only interactions. By eliminating the requirement for an initial in-person evaluation, the rule removes a significant barrier to treatment for individuals in rural and underserved areas. This change builds on temporary measures implemented during the pandemic, and reflects a commitment to making life-saving treatments more accessible. This rule goes into effect on February 18, 2025.

It is important to note that while these federal changes grant broader flexibility, practitioners must still adhere to applicable state laws when prescribing controlled substances. State regulations may impose additional restrictions or requirements beyond federal guidelines, particularly concerning the types of substances prescribed, patient eligibility and documentation. For example, while the new federal rules will allow a registrant to prescribe an initial six-month supply of  buprenorphine through a remote encounter, Ohio law only allows practitioners to prescribe a 30-day supply of buprenorphine at one time for the first 12 months of treatment.[iii] Healthcare providers must understand and comply with both federal and state laws to avoid legal pitfalls and ensure patient safety. This dual-layered compliance underscores the complexity of telemedicine practices in the United States.

The American Society of Addiction Medicine (ASAM) has strongly endorsed this rule, highlighting its importance in combating the opioid epidemic. ASAM President Dr. Brian Hurley noted that the rule’s improvements over earlier DEA proposals demonstrate a thoughtful approach to patient care.[iv]

Special registrations for telemedicine

Another significant development is the proposed rule on special registrations for telemedicine.[v] This rule allows practitioners to prescribe Schedule III-IV controlled substances without an initial in-person evaluation, provided they meet specific eligibility criteria. Applicants must hold a valid DEA registration and comply with state licensing requirements. The proposal also permits both audio-video and audio-only telemedicine encounters, ensuring flexibility in delivery methods. This initiative aims to expand access to care while preventing the misuse of controlled substances, offering a clear pathway for practitioners to engage in telemedicine safely and effectively.

Additionally, certain specialties will be able to hold an Advanced Telemedicine Prescribing Registration to prescribe Schedule II controlled substances without an in-person visit. These specialties include psychiatrists, hospice care physicians, physicians rendering treatment at long-term care facilities and pediatricians. The DEA is seeking public comment on additional medical specialists that should be authorized to issue Schedule II medications and as well as comments on additional patient protections. Public comments for this proposed rule must be submitted by March 18, 2025.

Continuity of care for Veterans Affairs patients

Finally, Veterans Affairs (VA) patients are also at the center of these regulatory changes. A new rule enables DEA-registered practitioners to prescribe controlled substances to VA patients through telemedicine encounters without requiring an in-person evaluation if the patient has previously been seen by a VA practitioner.[vi] The rule exempts VA practitioners from Special Registrations requirements. This measure addresses the unique healthcare needs of veterans, many of whom reside in remote or underserved locations. By leveraging telemedicine technologies, the rule enhances the continuity of care for this population. Safeguards, such as strict documentation requirements and adherence to prescribing guidelines, ensure that patient safety remains a top priority. This rule goes into effect on February 18, 2025.

Telemedicine continues to change and grow in the United States. Dinsmore will keep you updated on the latest developments in this field. In the meantime, if you have any questions about the new DEA telemedicine rules or about telemedicine in general, please do not hesitate to contact your Dinsmore attorney.