As November approaches, a significant regulatory change is on the horizon for telehealth and controlled substance prescribing, with the Drug Enforcement Administration (DEA) set to release its proposed rule. After a six-month delay, the DEA’s decision will shape the future of telehealth addiction treatment in the behavioral health sector and could redefine how treatment for substance use disorders (SUD), opioid use disorder (OUD), and other behavioral health conditions is delivered in the post-COVID world.
The pandemic-era regulations that allowed for greater flexibility in prescribing medications via telehealth have been instrumental in providing accessible care, especially for addiction treatment. During the public health emergency (PHE), addiction treatment providers leaned heavily on telehealth addiction treatment to address the growing opioid crisis and expand access to care. Telehealth’s role in addiction recovery programs flourished, drawing in new patients and increasing investment in digital health. In fact, 2021 marked a peak year for venture capital investment in digital health, with companies in the space receiving a record $29.3 billion. However, in 2022, that figure dropped to $15.3 billion, though it rebounded in 2023, signaling that digital health’s growth isn’t slowing down.
For many digital health companies, the pandemic created a unique opportunity to bring telehealth addiction treatment services to patients who might otherwise struggle to access care. In fact, almost 164 million Americans—roughly 49% of the population—live in areas with a shortage of mental health professionals, according to federal data. Telehealth, by making services more convenient and accessible, has helped address this shortage. However, now that the public health emergency has ended, companies offering telehealth-based services must contend with the looming uncertainty of whether the DEA will reinstate in-person examination requirements before prescribing controlled substances.
A Step Backwards for Telehealth Addiction Treatment and Access to Care
One of the most significant provisions of the DEA’s proposed rule is the possible reinstatement of in-person examinations as a requirement before prescribing certain controlled substances. This rule would have far-reaching implications for telehealth addiction treatment providers, particularly those in the addiction treatment space. During the pandemic, telehealth addiction treatment provided a lifeline for addiction treatment programs, especially for individuals seeking medication-assisted treatment (MAT) for opioid use disorder. The temporary relaxation of regulations allowed providers to prescribe medications like buprenorphine via telehealth without requiring an in-person exam.
But with the proposed regulatory change, addiction treatment providers would need to re-establish or expand in-person facilities, or forge partnerships with local healthcare providers to meet this new requirement. For companies like Ophelia Health, which operates virtually to provide OUD treatment, reinstating in-person exams could create significant barriers to care. According to Ophelia Health’s Vice President of Clinical Operations, Emily Behar, as many as 79% of the company’s patients did not have a primary care provider when they first sought help. Requiring in-person exams could deter these patients from pursuing treatment, which would exacerbate the opioid crisis and further isolate individuals struggling with addiction, particularly those without access to primary care services.
While many executives and providers in the telehealth addiction treatment space are bracing for the possibility of stricter regulations, there’s also hope that the DEA will take into account the overwhelming public feedback that opposes reinstating the in-person exam requirement. There are signs that the DEA may heed this feedback, especially given the important role telehealth has played in providing accessible care to millions of Americans. As Dylan Beynon, CEO of Mindbloom, a virtual ketamine-assisted therapy provider, noted, “We’re confident that they won’t rip telehealth away from the millions of Americans who depend on it.” The DEA’s proposed rule currently includes provisions that would allow prescriptions for certain drugs to be issued for up to 30 days without requiring an in-person exam, giving patients time to complete one course of treatment.
The Debate Over Telehealth Addiction Treatment and Controlled Substances
Telehealth proponents are optimistic that the DEA will understand the importance of maintaining access to telehealth addiction treatment for addiction treatment and behavioral health care. Previous research has shown that virtual addiction treatment leads to a lower likelihood of fatal overdoses and provides similar benefits to in-person care. Moreover, digital health services have been associated with higher retention rates, and federal research indicates that increasing access to medication-assisted treatments via telehealth has not led to an increase in overdose rates.
Despite these promising findings, some companies are taking a more cautious approach, preparing for the worst-case scenario where the DEA’s new rule could restrict access to virtual care. Digital health providers that had already established the infrastructure for in-person examinations, such as Workit Health, are somewhat better positioned to adjust to the potential in-person exam requirement. However, companies like Ophelia Health and Bicycle Health, which operate exclusively online, are facing more challenges in adapting to the uncertainty surrounding the DEA’s final decision.
In addition to the regulatory changes, the DEA is exploring the creation of a special registration process for telehealth-only prescribing, which could mitigate some of the challenges providers are anticipating. This special registration would allow telehealth addiction treatment providers to prescribe controlled substances without requiring in-person exams. Advocates for telehealth-based addiction treatment are hoping that this special registration process will become a viable solution to ensure that patients continue to have access to the medications they need.
Strategic Adaptation: Preparing for All Outcomes
While uncertainty looms, many providers are taking proactive steps to adapt to the potential regulatory shift. Workit Health, for example, has long maintained office locations where in-person exams can be conducted, leaving the company in a stronger position to comply with any in-person exam requirements. Similarly, Bicycle Health, which specializes in virtual OUD treatment, has made changes to its technology infrastructure to assist patients in arranging in-person exams when needed.
Boulder Care, a virtual addiction treatment provider, has taken a different approach by building strong partnerships with local health systems and community-based organizations to create a safety net for patients who might need to see a provider in person. Boulder Care’s CEO, Stephanie Strong, explained that their go-to-market strategy has always involved establishing deep roots in the communities they serve, which has allowed them to build strong referral networks and create pathways for patients to access care.
Even with strategic preparations in place, the uncertainty surrounding the DEA’s proposed rule is forcing companies to plan for all potential outcomes. Ophelia Health, for instance, is exploring various options, but the final decision will depend on how the DEA rules.
Advocacy and the Future of Telehealth Addiction Treatment
As the DEA considers the comments submitted during the public feedback period, several telehealth addiction treatment companies are gearing up to continue advocating for their patients and clinicians. Research supporting the effectiveness of virtual addiction treatment, especially in the treatment of OUD, could play a key role in influencing the final regulations.
Companies like Bicycle Health and Talkiatry are actively pushing for more flexibility in prescribing controlled substances via telehealth. Bicycle Health’s CEO, Ankit Gupta, emphasized that the company’s focus remains on ensuring that patients continue to have access to safe, effective, and easily accessible treatment. Talkiatry, which offers virtual psychiatry services, has also signaled its intention to present its proprietary data and strategies to the DEA to address concerns about drug diversion while increasing access to care.
These efforts represent the broader push to ensure that telehealth addiction treatment remains an integral part of the behavioral health landscape, especially as digital health solutions have proven to increase patient retention, reduce overdose rates, and expand access to care.
Conclusion: The Road Ahead for Telehealth Addiction Treatment and Addiction Care
The outcome of the DEA’s proposed rule will have a profound impact on the future of telehealth addiction treatment and behavioral health. Providers are facing an uncertain future, but one thing is clear: telehealth addiction treatment will continue to be a vital component of care for millions of patients. Whether the DEA decides to maintain the flexibility introduced during the pandemic or reinstates stricter regulations, the telehealth community is preparing to advocate for solutions that ensure patients have uninterrupted access to the treatment they need.
As the regulatory landscape evolves, collaboration between digital health companies, primary care providers, and policymakers will be essential in shaping the future of telehealth addiction treatment and behavioral health care. The push for increased access to care will remain a central focus as the DEA works to finalize its decision. Until then, providers will continue to plan for all potential outcomes, ensuring that their patients receive the best possible care—whether in person or through telehealth.
