The Drug Enforcement Administration (DEA) published a yearlong extension of telemedicine prescribing flexibilities for controlled substances Tuesday, just one day before the end of the year, when the flexibilities would expire.
The so-called “fourth temporary extension” represents an unsolved debate entering its sixth year: How can the DEA keep controlled substances from being abused via the internet in the era of telehealth?
Because the Department of Health and Human Services and the DEA haven’t figured out a long-term solution, the pandemic-era prescribing flexibilities for controlled substances remain in place, now extended for a fourth time since the end of the public health emergency in May 2023.
The fourth extension will last from Jan. 1, 2026, to Dec. 30, 2026. It allows registered providers to prescribe controlled substances in classes 2 through 5 to patients via telehealth visit when they’ve never met in person. The extension does not add any new requirements for patients and providers and continues the status quo of virtual prescribing since 2020.
The extension also implements two other controlled substance final rules, one for buprenorphine prescribing and the other for Veterans Affairs (VA) patients.
The fourth extension points to the recent government shutdown as an example of the detriment that can be caused by an abrupt telemedicine cliff. The DEA cites a review of electronic medical record data by Brown University that found the shutdown resulted in a 24% reduction of fee-for-service telemedicine visits in the first 17 days of the shutdown. In some states, the researchers found a 40% reduction in use of telehealth during the shutdown.
“The abrupt 41-day cessation of Medicare’s telemedicine flexibilities on September 30, 2025, previewed the negative impact a telemedicine cliff has on patients’ access to care when no permanent laws or regulations are in place when such flexibilities expire,” the rule says.
The DEA said the fourth extension will allow it time to promulgate a final rule for the future of telehealth prescribing of controlled substances while giving patients and providers time to adjust to the new requirements.
It will take into consideration the meetings it’s had with advocates and tribal nations as well as Biden’s proposed special registration rule.
“DEA supports telehealth access for patients who need medication, but not at the expense of public safety,” said DEA Assistant Administrator Cheri Oz, Diversion Control Division. “These rules aim to protect patients, expand access to care, and close the door on diversion into the illicit drug market.”
Advocates sent letters to DEA urging them to publish the fourth temporary extension to prevent disruptions in care.
“With only 25 days remaining before these critical telemedicine authorities expire, patients and providers are facing unacceptable uncertainty and the real risk of care disruptions. Providers are scheduling appointments with patients at least 30 days in advance. Any delay in the DEA policymaking will create confusion among patients, cancellations, and abrupt treatment gaps.”
The fourth extension also put into effect two rules that were finalized in the waning days of the Biden administration. Trump’s DEA delayed implementation twice, until the end of the year.
The buprenorphine rule allows for six months of prescribing buprenorphine virtually to a new patient that hasn’t been seen in person. Buprenorphine is a gold-standard treatment for opioid use disorder.
On its own, the rule does not provide a lasting solution to the issue of prescribing the opioid use disorder treatment via telehealth, as it relies on the existence of a special registration.
The Veterans Health Administration final rule allows for VA practitioners to prescribe Schedule 2-5 controlled substances via telemedicine without an initial in-person visit if another VA practitioner previously conducted one.
“We applaud DEA for acting to continue access to care for the millions of patients who depend on telehealth for essential medications,” Chris Adamec, executive director of the Alliance for Connected Care, wrote in a statement. “However, this should be the last time these Americans come within days of losing access to treatments they need. We call on DEA to engage stakeholders and develop a permanent framework to ensure safe access to prescriptions through telehealth.”
Publisher: Source link
