Federal officials said Friday that health care providers will be able to prescribe medications for opioid addiction and ADHD via telehealth for another year, ending a months-long standoff among policymakers.
During the pandemic, the Drug Enforcement Agency issued temporary rules allowing providers to prescribe controlled substances such as buprenorphine and Adderall without first meeting a patient in person. Those rules were set to expire on January 1 and have now been extended until the end of 2025. The extension kicks the resolution from a years-long debate — one that has already provoked nearly 40,000 responses to previously proposed rules — to the second. The Trump administration and agency leadership have yet to be determined.
The flexibility of the pandemic paved the way for a broader conversation about the strict rules that some say are hindering access to potentially life-saving treatments. It also turned out to be a boon for telehealth companies that provided care under the relaxed regime.
In 2023, the DEA released draft rules reintroducing restrictions criticized by telehealth advocates and providers, and last October extended the flexibility through the end of this year. The DEA has fallen short of its promise to issue final rules this fall, which a former official attributed to interagency conflicts and politics. The most recent draft rules put into circulation contain many restrictions, including requiring half of a provider’s prescriptions for controlled substances to be written for patients seen in person, and requiring health care providers to monitor their patients through programs for prescription drug monitoring in all fifty states.
When these restrictions were leaked, telehealth companies complained that they were unsustainable and that some services had to be closed. It has been clear for several months that DEA would have to extend the pandemic rules because there was not enough time for the agency to issue final rules before the end of the year.
Many read these circulating regulations as an indictment of companies that prescribe too many stimulants to make a profit; in June of this year, leaders of the ADHD-focused telehealth company Done were arrested on suspicion of participating in a scheme to distribute controlled substances online. Limiting the extension to just one year, the temporary rule states, aims to “avoid incentivizing the investments necessary to develop new telemedicine businesses that could encourage or enable problematic prescribing practices.”
Telehealth companies and advocates agreed on the need for oversight to prevent fraudulent and harmful prescribing that could lead to abuse, but many worried it would reverse progress in opioid addiction care. Companies that prescribe buprenorphine online have been particularly outspoken in favor of continued remote addiction treatment protections.
The temporary rule also cited the “urgent public health need for continued access to buprenorphine as a medication for opioid use disorder” as motivation for the extension. While advocates for buprenorphine access are celebrating the expansion, “it is still a temporary measure and therefore insufficient from our perspective,” said Stephanie Strong, CEO and founder of Boulder Care, a telemedicine addiction medicine company. “Telecare is not just a novelty or an emergency measure. It is a necessity.”
The extension resolves one of several telehealth policies set to expire at the end of the year. Congress is currently considering legislation that would extend the rules for another two years, allowing Medicare enrollees to receive a wide range of services via telehealth.