The Drug Enforcement Administration (DEA) is facing mounting pressure from leading health care and behavioral health organizations for failing to create a special telehealth registration process that would allow providers to remotely prescribe certain medications for substance use disorder (SUD) treatment. More than two years after Congress mandated action, advocates say the agency’s delay is undermining access to lifesaving care.
At the heart of the issue is medication-assisted treatment (MAT), widely considered the gold standard in treating opioid use disorder (OUD). Despite strong evidence of its effectiveness, many patients still face barriers to accessing MAT, especially in rural communities or areas without specialized treatment providers. Telehealth offers a solution, but existing regulations continue to complicate its use.
Now, more than 80 organizations — including the National Council for Behavioral Health and the American Psychiatric Association — have come together to demand action from the DEA. Their message is clear: it’s time to move forward and permanently expand telehealth access for SUD treatment.
The Origins Of The Special Registration
The push for a telehealth registration process goes back to October 2018, when the SUPPORT Act was signed into law. Among its many provisions to combat the opioid epidemic, the law required the DEA to establish a special registration process for qualified providers. This would allow them to prescribe controlled substances for MAT via telemedicine without the need for an initial in-person visit.
Normally, the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 prohibits such prescribing until a doctor has physically seen a patient. While designed to prevent the abuse of online pharmacies, the law inadvertently created barriers for patients in need of evidence-based care for substance use disorders. Congress attempted to address that barrier by requiring the DEA to act.
By October 2019, the agency should have issued regulations outlining how the process would work. Yet a full year later, and two years after the SUPPORT Act was signed, the DEA has still not finalized the rule.
Advocacy Groups Step Up The Pressure
The continued delay prompted more than 80 organizations to sign a letter addressed to DEA Acting Administrator Timothy Shea. Their appeal pointed to the urgent need to remove unnecessary obstacles that prevent patients from getting treatment for opioid use disorder.
“The undersigned organizations write to encourage the DEA to expedite and complete its efforts to implement a telemedicine special registration process enabling providers to safely prescribe controlled substances remotely,” the letter stated.
The groups emphasized that the COVID-19 pandemic has already demonstrated the value of telemedicine in expanding access to care. Providers have quickly adapted to virtual services, and patients across the country have benefited from not having to travel to receive prescriptions. For individuals in rural communities, treatment deserts, or without reliable transportation, tele-prescribing can mean the difference between ongoing addiction and recovery.
COVID-19 Shines A Light On Access Challenges
The urgency of this issue has grown significantly during the coronavirus pandemic. According to the Centers for Disease Control and Prevention (CDC), overdose deaths have risen sharply since the onset of COVID-19. Stress, isolation, economic instability, and limited access to in-person services have all contributed to worsening conditions for those struggling with addiction.
In response, both the Department of Health and Human Services (HHS) and the DEA issued temporary waivers that allowed providers to prescribe MAT remotely without requiring an initial in-person evaluation. These measures made it possible for many patients to continue treatment without interruption.
However, the advocacy organizations caution that these temporary flexibilities are not enough. “While we appreciate these public health emergency-related changes, statute requires the implementation of a permanent regulation,” they wrote. “The time for that regulation is long overdue.”
The Importance Of MAT In Combating The Opioid Crisis
MAT combines FDA-approved medications such as buprenorphine, methadone, and naltrexone with counseling and behavioral therapies. Decades of research have shown that MAT reduces opioid use, lowers the risk of overdose, and improves long-term recovery outcomes. It is also associated with better retention in treatment and improved social functioning.
Despite its effectiveness, MAT remains underutilized. Many communities, especially rural ones, lack enough trained providers to meet the demand. Patients often face long wait times, have to travel long distances, or forgo treatment entirely due to logistical barriers.
Telehealth offers a critical pathway to bridge this gap. By allowing qualified providers to prescribe MAT virtually, the special registration process would make treatment more accessible to patients no matter where they live.
The Ryan Haight Act And Its Unintended Consequences
One of the key barriers to tele-prescribing MAT lies in the Ryan Haight Act of 2008. Designed to combat rogue online pharmacies, the law requires providers to conduct at least one in-person medical evaluation before prescribing controlled substances. While effective at curbing illegal prescribing, it created unintended consequences for patients needing legitimate care for opioid use disorder.
The SUPPORT Act sought to remedy this by requiring the DEA to create a special registration process. But without timely action from the DEA, patients and providers remain stuck in a regulatory limbo.
Why The Delay Matters
The consequences of the DEA’s delay are not just bureaucratic — they are life and death. Every day, patients struggling with addiction face barriers to accessing care. For those in underserved communities, the inability to access MAT through telehealth can mean going without treatment altogether.
Advocacy groups argue that the DEA’s failure to act undermines the intent of Congress and the urgent need to address the opioid epidemic. With overdose deaths on the rise, the lack of a permanent telehealth prescribing option threatens to stall progress in fighting addiction.
Looking Ahead
The letter from more than 80 organizations reflects a broad consensus across the behavioral health field: permanent telehealth solutions are essential to the future of addiction treatment. From national advocacy groups to professional associations, the message is unified and strong.
Moving forward, the DEA has the authority and responsibility to implement the special registration process. Doing so would not only fulfill the mandate of the SUPPORT Act but also expand access to evidence-based care at a time when it is needed most.
For now, temporary flexibilities remain in place due to the COVID-19 public health emergency. But without a permanent regulatory solution, patients and providers remain vulnerable to shifting rules and uncertainty.
Conclusion
The opioid epidemic remains one of the most pressing public health crises in the United States. Medication-assisted treatment has proven to be one of the most effective tools in combating addiction, yet access remains uneven and limited. Telehealth offers a powerful way to expand MAT access, especially in underserved areas.
The DEA’s failure to act on its mandate from the SUPPORT Act has left patients without the full benefits of telehealth-enabled treatment. With overdose rates climbing and the pandemic exposing gaps in the health care system, advocacy groups are right to demand urgent action.
By creating the long-overdue special registration process, the DEA could take a decisive step toward improving access to lifesaving care. The future of addiction treatment may well depend on it.
