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May 2023 Update: On May 9, 2023, the Drug Enforcement Agency (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) announced the temporary extension of flexibilities around telemedicine prescribing of controlled substances from the COVID-19 public health emergency (PHE). This extension will allow time for the DEA to comprehensively review and incorporate the more than 38,000 comments received on the two companion proposed rules they released in March 2023, detailed below.
The emergency flexibilities will be extended in full until November 11, 2023 (6 months after the end of the PHE). These flexibilities include:
- Patients can be prescribed schedules II-V controlled substances without a prior in-person examination as clinically appropriate and within your normal scope of practice, including through audio-only modalities.
- DEA registration in one state allows prescription of controlled substances in any state.
After November 11, 2023, there is a one-year "off-ramp" that applies to patients that established a treatment relationship via telemedicine and were prescribed a controlled substance(s) during the PHE waivers (from March 2020 up to November 11, 2023). In other words, if the practitioner and patient have established a telemedicine relationship involving the prescription of controlled substances on or before November 11, 2023, the telemedicine flexibilities for the prescribing of controlled substances will apply to them through November 11, 2024. New patients established after November 11, 2023 will not be granted use of those flexibilities.
This means that without the promulgation of additional rules, on November 12, 2023, in-person rules, as well as DEA registration rules, will apply to new patients and on November 12, 2024, in-person and registration rules will apply to established patients. The rules that will apply on these dates will depend on what rules the DEA finalizes, so stay tuned for more information.
DEA and SAMHSA are still reviewing the comments received in March to finalize updated rules regarding telemedicine prescribing of controlled substances after these flexibilities expire. APA submitted comments on March 31st to both the Telemedicine Prescribing of Controlled Substances Proposed Rule and the Expansion of Induction of Buprenorphine via Telemedicine Encounter Proposed Rule.
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