The Drug Enforcement Administration (DEA) has taken a historic step in shaping the future of telehealth prescribing regulations by hosting a public listening session—a rare move for an agency that has traditionally maintained rigid policies without broad public engagement. This session, held on Tuesday, marks a pivotal moment in the ongoing debate over how controlled substances should be prescribed via telemedicine post-pandemic.
Behavioral health executives, policy experts, and medical professionals used the opportunity to strongly advocate for maintaining the virtual prescribing flexibilities that expanded access to care during COVID-19. The discussion comes at a critical time, as the DEA considers reinstating stricter telehealth prescribing regulations, including a proposed rule that would require in-person evaluations before prescribing controlled substances via telehealth. The agency delayed implementing this rule after receiving over 30,000 public comments—one of the highest response rates in its history—largely opposing the restrictions.
A Historic Shift in DEA’s Approach
This listening session represents an unprecedented approach for the DEA, which has historically resisted changes to telehealth prescribing regulations and blocked the implementation of a special registration process for telehealth prescribing of controlled substances. However, the overwhelming public response forced the agency to rethink its approach.
“This listening session is novel for the DEA in that we have not generally held public meetings to inform our regulatory drafting efforts,” said Matthew Strait, deputy assistant administrator for the DEA. “I hope that this effort underscores our desire to improve upon our information-gathering capabilities to better inform this important work. At no time has this novel approach been more logical and more appropriate.”
Strait emphasized that future telehealth prescribing regulations will impact the delivery of healthcare for millions of Americans, making it essential to “get it right.”
During the session, DEA Administrator Anne Milgram reaffirmed the agency’s commitment to listening to stakeholders, stating that they are reopening the conversation on telehealth prescribing regulations in response to the widespread concerns expressed in public comments.
Industry Leaders Defend Telehealth Prescribing
The session featured testimony from 61 commentators, including behavioral health executives, psychiatrists, and policy advocates, many of whom argued that returning to stricter in-person requirements would severely limit access to essential care, particularly for mental health and addiction treatment.
Robert Krayn, CEO and co-founder of Talkiatry
Robert Krayn shared a personal account of struggling to find a psychiatrist after experiencing a traumatic home invasion in 2016. Despite living in one of the largest cities in the country, he found it nearly impossible to secure an appointment, describing the process as inefficient and inaccessible.
“You email 20 doctors, and whoever responds is the doctor you go and see. There’s a very high likelihood that that’s not the right doctor for you, and an even higher likelihood that you’re not the right patient for that doctor,” Krayn explained.
He went on to emphasize that in-person visits do not automatically equate to quality care. Instead, the flexibility provided by telehealth over the last three years has transformed access to mental health services for millions. Krayn urged the DEA to finalize a special registration process that would allow continued virtual prescribing of controlled substances, calling it an overdue policy shift that has been ignored by multiple administrations.
Dr. Shabana Khan, American Psychiatric Association & American Academy of Child and Adolescent Psychiatry
Dr. Shabana Khan advocated for an expanded and data-driven approach to telehealth prescribing regulations. She argued that any special registration process should not be restricted to specific diagnoses or conditions. Instead, she proposed that the DEA collaborate with healthcare agencies to integrate data sources, develop advanced monitoring algorithms, and create better tools to identify bad actors.
Additionally, Dr. Khan suggested that DEA audits of prescribing practices should include clinical expertise to ensure that enforcement measures are fair and based on medical necessity rather than arbitrary restrictions. She also pushed for a national prescription drug monitoring program (PDMP) database that would enhance oversight while preserving patient access to necessary medications.
Kyle Zebley, American Telemedicine Association
Kyle Zebley dismissed the idea that in-person evaluations prevent drug diversion, arguing that they do little more than create unnecessary barriers to care.
“We believe that a requirement that a patient see a clinician in person is not an effective control against diversion and instead simply limits access to legitimate health care,” Zebley said.
He warned that restricting telehealth prescribing regulations would drive patients toward illegal online drug sellers, exacerbating the very problem the DEA aims to prevent. He further emphasized that every state already recognizes telehealth as a legitimate method for establishing a patient-provider relationship, meaning that additional federal restrictions are both redundant and harmful.
Johns Hopkins Medicine’s Perspective
Johns Hopkins Medicine representatives shared compelling data demonstrating that telemedicine has become an integral part of modern healthcare.
- In 2022, 65% of outpatient psychiatry visits at Johns Hopkins were conducted via telemedicine.
- Over the past three years, 40% of psychiatry provider-patient relationships were maintained exclusively through telehealth—without a single in-person visit.
- Across multiple specialties—including psychiatry, neurology, genetics, surgery, and oncology—telehealth accounted for 13% of all outpatient care over the past year.
Johns Hopkins experts argued that telehealth prescribing regulations are crucial to meeting the Biden administration’s goal of expanding mental health access. They urged the DEA not to interfere with medical decision-making, emphasizing that virtual prescribing plays a vital role in ensuring continuity of care.
The Future of Telehealth and Controlled Substance Prescribing
The DEA’s willingness to engage in public discussions signals a potential shift in telehealth prescribing regulations, but the outcome remains uncertain. The agency will continue gathering input through another written comment period in the fall of 2023 before making any final decisions.
For now, the battle over telehealth prescribing regulations is far from over. The overwhelming support from healthcare leaders suggests that the push for permanent telehealth prescribing rights will continue. As policymakers weigh their options, the key question remains: Will the DEA embrace a modern, patient-centered approach, or will it revert to restrictive policies that could hinder access to vital care?
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