The Drug Enforcement Administration (DEA) is poised to release a new rule that could dramatically reshape the way behavioral health care is delivered via telehealth. This rule, if finalized, would impose strict limitations on the ability of healthcare providers to prescribe controlled substances remotely. For many in the telehealth space, this development signals a potential setback in the hard-fought gains made in expanding access to care, particularly for those with behavioral health issues.
Telehealth advocates, however, contend that the severity of the proposed rule will not only make prescribing controlled substances via telehealth nearly impossible—it will also undermine the burgeoning movement to offer more accessible, remote care for people struggling with mental health and substance use disorders. At a time when telehealth has proven to be a vital tool in providing care to underserved populations, the potential restrictions outlined by the DEA could reverse much of the progress that has been made, especially in rural and remote areas.
The Telehealth Boom and Behavioral Health Care
Telehealth has become a game-changer for many behavioral health providers, offering patients easier access to care and reducing barriers like long travel distances, wait times, and the stigma that often accompanies in-person visits to mental health professionals. During the COVID-19 pandemic, telehealth was heralded as a lifeline for millions, particularly those in remote areas or with limited access to mental health services. With the loosening of regulations surrounding telehealth, many patients could access vital medications and therapeutic interventions via remote consultations.
In behavioral health, controlled substances play a critical role in treating certain conditions. Buprenorphine, for example, is a widely used medication to treat opioid use disorder, while mixed amphetamine salts are prescribed for Attention Deficit Hyperactivity Disorder (ADHD). These medications are classified as controlled substances by the DEA and require careful regulation to prevent misuse. However, access to these medications has been severely limited in many areas, especially in rural regions where qualified mental health professionals are few and far between.
The relaxation of telehealth regulations during the pandemic enabled behavioral health providers to prescribe these controlled substances remotely, offering life-saving treatment to individuals who might otherwise be unable to obtain it. Advocates argue that these temporary flexibilities should be made permanent, as they have significantly improved patient outcomes and expanded access to care. However, the DEA Telehealth Rules threaten to undo these gains by placing strict limits on how and when controlled substances can be prescribed via telehealth.
The Proposed DEA Telehealth Rules: A Closer Look
The specifics of the DEA Telehealth Rules have yet to be formally released, but details have emerged through reports from Politico Pro, which cited a former federal official. While the full impact remains to be seen, several key provisions have sparked significant concern among telehealth advocates:
- Schedule II Drugs and In-Person Visits: Medications classified as Schedule II controlled substances, such as oxycodone and methadone, would only be allowed to be prescribed via telehealth if the prescriber is a specialist. In all other cases, an in-person visit would be required. This provision would severely limit the ability of behavioral health providers to prescribe critical medications remotely, especially for patients in rural areas where specialists may be scarce or unavailable.
- Limit on Telehealth Prescriptions: The proposed DEA Telehealth Rules would limit the number of prescriptions a provider can give via telehealth, with no more than half of a provider’s prescriptions being allowed to be issued remotely. This regulation would make it difficult for many telehealth providers to sustain their practices or meet the needs of patients who require ongoing treatment for chronic mental health conditions or substance use disorders.
- Prescription Drug Monitoring Program (PDMP) Checks: The DEA has proposed that telehealth providers check all 50 state prescription drug monitoring programs (PDMPs) before prescribing any controlled substances. While the intent is to ensure that controlled substances are not being over-prescribed or misused, this requirement could be burdensome for providers, especially those operating in multiple states or serving patients who frequently travel. It may also slow down the prescribing process, potentially delaying critical care.
- Schedule III, IV, and V Drugs: The new DEA Telehealth Rules would allow medications classified under these schedules (such as certain anti-anxiety medications, some stimulants, and medications for sleep disorders) to be prescribed via telehealth without the need for an in-person consultation. While this is seen as a partial victory, it still leaves many patients in need of Schedule II medications at risk of losing access to crucial care.
Industry Pushback: The Call for a Balanced Approach
Telehealth advocates have been vocal in their opposition to the DEA Telehealth Rules, arguing that it will have a detrimental impact on patients who depend on remote access to care. Many fear that the rules, if enacted, will leave patients without access to essential medications and treatment options, particularly in areas where in-person visits are difficult or impossible.
The concerns are especially pressing for rural patients who already face significant barriers to accessing care. According to Robert Krayn, CEO and co-founder of the virtual psychiatry company Talkiatry, the proposed rule could be disastrous for the telehealth industry. He told Behavioral Health Business that if the rule is finalized as currently written, it would be a “disaster,” cutting off access to vital care for many individuals.
In interviews with Politico Pro, some advocates expressed hope that the DEA would be willing to reconsider its approach in light of feedback from stakeholders. Reporting suggests that the DEA has already made some concessions, such as the exemption allowing specialists to prescribe Schedule II drugs via telehealth. This could be seen as an attempt to address concerns raised by commenters who argued that the previous approach was too restrictive. Some telehealth providers believe that with minor tweaks, the rule could strike a more reasonable balance between patient safety and accessibility.
Still, the fear remains that the DEA Telehealth Rules are overly focused on regulatory concerns and law enforcement priorities, rather than the needs of vulnerable patients who rely on telehealth for their ongoing care. Many advocates worry that the DEA’s role as both a healthcare regulator and a law enforcement agency could lead to overly strict regulations that limit access to essential care.
A Crossroads for Telehealth and Behavioral Health
The DEA Telehealth Rules represent a crossroads for telehealth and behavioral health care. On the one hand, there are valid concerns about the misuse and over-prescription of controlled substances. The DEA has an important role to play in ensuring that controlled substances are not being abused or diverted. On the other hand, telehealth has proven to be a crucial tool in expanding access to care, especially for patients who may not otherwise have access to treatment.
Advocates of telehealth emphasize that the current regulatory framework must be adapted to the realities of modern healthcare, which increasingly relies on digital tools and remote consultations. There is a growing recognition that telehealth is not just a temporary solution but an essential part of the future of healthcare. With behavioral health issues on the rise, it is vital that patients continue to have access to the medications and therapies they need, regardless of their location.
The telehealth community is watching closely as the DEA prepares to finalize its new DEA Telehealth Rules. Many hope that the agency will continue to listen to feedback from stakeholders and make necessary adjustments to ensure that patients can access care without unnecessary barriers.
The Road Ahead
As the DEA works toward finalizing its rule, the telehealth industry remains in a state of uncertainty. If the current proposals are adopted, they could significantly restrict access to behavioral health services, particularly for individuals who need medications like buprenorphine for opioid use disorder or stimulants for ADHD. However, if the DEA is willing to compromise, there may be a way to preserve the benefits of telehealth while still addressing concerns around the safe prescribing of controlled substances.
For now, telehealth providers, patients, and advocates are on high alert, waiting for the DEA to finalize its regulations. The fate of telehealth prescribing—and the future of behavioral health care delivery—may depend on the decisions made in the coming months. As we await further developments, one thing is clear: the fight for accessible, effective telehealth care is far from over.
Stay tuned for updates as the DEA prepares to release its new proposed rule on telehealth prescribing, and how these regulations may impact the future of behavioral health care.
