Telemedicine and controlled substances: the rules, explained
An educational explainer of the federal rules for prescribing controlled substances by telemedicine. This area changes often. The status below is current as of the date on this page; confirm the current DEA and HHS rules and your state law before prescribing.
Extra caution: Controlled-substance and telemedicine rules change frequently and vary by state. Verify the current DEA and HHS rules and your state law before prescribing. This is educational information, not legal or clinical advice.
Current as of July 7, 2026. Laws, payer rules, and billing codes change, so confirm the current requirements for your jurisdiction and setting before you rely on it.
What's inside
The baseline rule
The Ryan Haight Act generally requires at least one in-person medical evaluation before a clinician prescribes a controlled substance, with specific exceptions. Telemedicine flexibilities have modified this in practice.
Current status
- As of July 7, 2026, the DEA and HHS have extended the COVID-era telemedicine flexibilities through December 31, 2026
- Under the extension, DEA-registered practitioners may prescribe Schedule II-V controlled medications by real-time audio-video telemedicine without a prior in-person evaluation, if the prescription otherwise complies with DEA and applicable federal and state law
- The agencies have proposed, but not finalized, a permanent framework, including a proposed special registration for telemedicine
- Whether and how a permanent rule takes effect remains unsettled
What has not changed
- You still need a valid DEA registration and any required state controlled-substance registration
- State law still applies and can be stricter than federal law
- Licensure and prescribing follow the patient's physical location
- Check the prescription drug monitoring program where required
Why the date matters
These flexibilities have been extended several times and are under active rulemaking. Do not rely on this summary as current. Confirm the DEA and HHS rules in effect on the day you prescribe.
About this resource
This reference is part of the shrinkiatry resource library, a set of free, clinician-facing references and examples. It's reviewed by Shariq Refai, MD, MBA, FAPA, a board-certified psychiatrist, on a quarterly schedule. Next scheduled review: October 1, 2026. First published July 7, 2026, last reviewed July 7, 2026.
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