The Trump administration is on the verge of extending a temporary rule that allows health providers to prescribe certain controlled substances, such as ADHD medications and treatments for opioid addiction, through telemedicine. This rule, enacted by the Drug Enforcement Administration in March 2020 as the Covid-19 pandemic surged, permits providers to initiate prescriptions for drugs like Ritalin, Adderall, or buprenorphine without an in-person examination.
This potential extension would mark the fourth time the federal government has prolonged these flexibilities without making a permanent decision on how telemedicine prescribing of controlled substances will be regulated. The White House budget website recently posted information about the “Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications,” indicating that this regulatory uncertainty will persist for at least another year.
Over the past five years, these temporary telehealth flexibilities have led to the rise of businesses focused on remote prescribing of controlled substances. While some critics have expressed concerns about the potential for misuse or addiction when prescribing stimulants or opioid use disorder treatments without an in-person examination, research has shown that patients receiving ADHD medications via telehealth do not experience higher rates of addiction or adverse effects compared to those seen in person by a doctor.
The ongoing regulatory limbo underscores the Biden administration’s delay in finalizing a telehealth rule. Despite the initial proposal to reintroduce some restrictions facing backlash, including from Democratic lawmakers, an updated proposal unveiled in January 2025 came too late to be finalized. It included a long-awaited proposal for a special registry for telemedicine prescribers of controlled substances and limitations on the percentage of prescriptions that can be written via telehealth.
The Trump administration’s approach to finalizing regulations for prescribing controlled substances via telemedicine remains uncertain. Key issues under debate include differentiating between Schedule II and Schedule III substances and how stimulants used for ADHD should be regulated. Terry Cole, the new head of the DEA, has been noncommittal on the future of telehealth services for substance use disorders, pledging to give the matter careful consideration.
Aside from controlled substances, telehealth more broadly has faced challenges, with a recent analysis showing a significant drop in telehealth visits under Medicare following a government shutdown. This disruption highlights the importance of establishing clear regulations and support for telehealth services to ensure continued access to care for patients.
In conclusion, the evolving landscape of telemedicine and the prescribing of controlled substances reflect the ongoing need for thoughtful regulation and oversight to balance patient access with safety and quality of care. The intersection of technology and healthcare presents both opportunities and challenges that require careful consideration and collaboration among policymakers, healthcare providers, and industry stakeholders.
