Can My Doctor Prescribe a Controlled Substance Over the Phone or Via Telehealth?

The Pre 2020 Rule: In Person Required

Before the COVID 19 public health emergency, federal law under the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 required that a prescriber conduct at least one in person medical evaluation of a patient before prescribing a controlled substance.

This rule existed to prevent the kind of online pill mills that had proliferated in the early 2000s, websites where patients could fill out a brief questionnaire and receive an opioid prescription without ever being examined by a physician.

The in person requirement was a meaningful safeguard. It also created real barriers for patients in rural areas, patients with mobility limitations, and patients whose access to specialty care was already restricted.

What Changed During the Public Health Emergency

In March 2020 the DEA exercised its emergency authority to waive the in person evaluation requirement for controlled substance prescribing via telehealth. This meant that for the duration of the public health emergency, practitioners could prescribe Schedule III through V controlled substances, and in some cases Schedule II medications, via telehealth without a prior in person visit.

This was a significant policy shift. Patients with ADHD, anxiety disorders, chronic pain, and other conditions managed with controlled substances could now access prescriptions through telehealth platforms without first establishing an in person relationship with a prescriber.

Where the Rules Stand Now

The federal public health emergency ended in May 2023. The DEA and the Department of Health and Human Services have been working through the regulatory process of establishing permanent rules for telehealth prescribing of controlled substances.

As of the current date the DEA has implemented a set of telemedicine prescribing rules that allow for some continued telehealth prescribing of controlled substances under specific conditions, including for patients who had an established telehealth relationship during the public health emergency, and for certain medication assisted treatment programs.

The rules are specific, they vary by medication schedule, and they continue to evolve. For the most current and accurate guidance applicable to your specific medication and prescriber, the best source is your prescriber’s office and your pharmacist, both of whom are required to stay current on the applicable regulations.

What This Means Practically for Patients

For patients currently receiving controlled substances via telehealth: Your prescriber’s ability to continue prescribing via telehealth depends on the specific medication, the platform they use, and whether the current DEA rules cover your situation. If your telehealth prescriber has told you that they can continue prescribing your controlled substance via telehealth, they should be able to explain specifically which regulatory provision covers that prescribing.

For patients seeking to establish a new controlled substance prescription via telehealth: The rules here are more restrictive for new patients seeking Schedule II medications specifically. An in person evaluation may be required before a telehealth prescriber can initiate a new Schedule II prescription. Your telehealth platform should be able to tell you upfront whether an in person visit is required for your specific situation.

For patients in rural Mississippi and the Gulf Coast: Access to in person specialty care, psychiatry, pain management, and neurology in particular, remains genuinely limited in many parts of Mississippi. The telehealth prescribing rules have real quality of life implications for patients who rely on remote prescribers for controlled substance management. If you are navigating this situation, your pharmacist is a useful resource for understanding what the current rules mean for your specific medication and what options are available to you.

The Medication Assisted Treatment Exception

One important area where telehealth prescribing of controlled substances has been specifically protected is medication assisted treatment for opioid use disorder, specifically buprenorphine products like Suboxone and Sublocade.

The DEA has implemented specific provisions allowing buprenorphine prescribing via telehealth for patients in opioid use disorder treatment programs, recognizing that access barriers in this population have particularly serious consequences. If you or someone you know is in a medication assisted treatment program, talk to your prescriber or pharmacist about how the current rules affect your specific treatment access.

The Bottom Line

Telehealth prescribing of controlled substances is legal under specific conditions that depend on the medication schedule, the prescriber’s platform, and the nature of the patient prescriber relationship. The rules are in a period of regulatory evolution and will continue to be refined.

If you are unsure whether your telehealth prescriber can legally prescribe your specific controlled substance under current rules, ask them directly to cite the regulatory basis. If something does not add up, your pharmacist is your best resource for verification.

This article is for general information only and is not a substitute for personalized medical advice. Before starting or changing any medication, including over the counter products and supplements, talk with your pharmacist or physician about your specific situation.