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Telehealth visit with doctor on tablet.

Federal government extends COVID-19 telehealth prescription flexibilities for controlled medications

May 10, 2023

Federal agencies have temporarily extended provisions in the COVID-19 public health emergency (PHE) that allow the prescribing of controlled medications, including buprenorphine, via a telehealth visit without requiring an in-person medical evaluation. The flexibilities were set to expire when the PHE ended Thursday, but they have been extended through Nov. 11.

In addition, the telehealth flexibilities will be extended through Nov. 11, 2024, for patients and practitioners who establish a telemedicine relationship on or before Nov. 11, 2023.

Under the PHE, the Drug Enforcement Administration (DEA) granted temporary exceptions to regulations regarding the prescribing of schedule II–V controlled substances to prevent lapses in care. This includes buprenorphine, which is used to treat opioid use disorder, and medications used to treat attention-deficit/hyperactivity disorder.

The Food and Drug Administration (FDA) approved the use of buprenorphine, a partial opioid agonist, in patients 16 years and older in 2002. In 2019, an estimated 87,000 adolescents ages 12-17 years and 515,000 young adults ages 18-25 years had an opioid use disorder in the previous year, numbers that skyrocketed during the COVID-19 pandemic, according to the Centers for Disease Control and Prevention (CDC). In 2020, an estimated 2.7 million people ages 12 and older reported having an OUD, according to the CDC.  

In 2016, the AAP published a policy statement that encouraged pediatricians to offer medication for the treatment of opioid use disorder in adolescents and young adults.

Under the temporary extension, practitioners are allowed to continue to prescribe controlled medications approved by the FDA for maintenance and withdrawal management treatment of opioid use disorder via audio-only telemedicine encounters, without requiring an in-person medical evaluation if such prescriptions otherwise comply with the requirements outlined in DEA guidance documents, DEA regulations and applicable federal and state law.

With the telehealth flexibilities due to expire, the DEA and Department of Health and Human Services (HHS) began soliciting comments on two proposed rules to allow for prescribing of controlled medicines via telemedicine when the prescribing practitioner has never conducted an in-person medical evaluation of the patient. The purpose of the proposed rules was to make permanent some of the telemedicine flexibilities established during the COVID-19 PHE to facilitate patient access to controlled medications via telemedicine when consistent with public health and safety, while maintaining effective controls against diversion.

More than 38,000 public comments were received and are being reviewed. Final rules are anticipated from the DEA and/or the Substance Abuse Mental Health Services Administration.


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