These prescriptions could still be allowed without an in-person consultation or referral from a medical practitioner who has conducted an in-person consultation. Beyond 30 days, to continue subscribing to that patient, “the prescribing practitioner would be required to examine the patient in person,” the rule stated. Schedule II medications or narcotics would require in-person prescriptions. 

“DEA is committed to ensuring that all Americans can access needed medications,” said DEA Administrator Anne Milgram. “The permanent expansion of telemedicine flexibilities would continue greater access to care for patients across the country, while ensuring the safety of patients. DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm.”

The American Telemedicine Association (ATA) called out the proposed rules for being too restrictive at a time when the United States is still dealing with the impact of the COVID-19 pandemic. Limiting telemedicine prescription abilities could impact access and potentially disrupt care for many who have been using telemedicine for the last three years.

“The proposed rules from the DEA are significantly more restrictive than is warranted,” Kyle Zebley, the ATA’s senior vice president of public policy and executive director, ATA Action, said in a statement. “Our concern lies with the potential public health crisis this could cause for individuals needing access to clinically appropriate prescriptions of controlled substances for a wide variety of medical circumstances, including for mental health and substance use disorders. The continuity of care for countless Americans will be severed, potentially leaving these patients to fall through the cracks of our healthcare system without access to needed medications.”

Telemedicine filled a critical care gap during the COVID-19 pandemic, and the public health emergency enabled more flexibilities for telemedicine to ensure Americans had access to care. However, federal authorities have been cracking down on the prescribing of narcotics and controlled substances via telehealth. 

One company that recently became the focus of the Department of Justice was Cerebral, which came under investigation by the agency in 2022 for possible criminal violations of the Controlled Substances Act. The telehealth company treats a variety of conditions, including depression, anxiety disorders, ADHD, PTSD and serious mental illnesses such as bipolar disorder and opioid use disorder through its virtual services. At the time the investigation was announced, Cerebral paused the practice of prescribing controlled substances as a treatment for ADHD such as Adderall and Ritalin for new patients.