Telemedicine controlled-substance prescribing tracker
Where the federal rules stand on prescribing controlled substances by telemedicine, with every change dated and linked to the Federal Register. We check for changes every month.
Source: Fourth Temporary Extension, 90 FR 61301 (December 31, 2025), federalregister.gov.
As of September 29, 2026, a DEA-registered practitioner can prescribe Schedule II through V controlled substances by telemedicine without ever seeing the patient in person, under a temporary rule that runs through December 31, 2026. Two permanent rules are also in effect, one for buprenorphine to treat opioid use disorder and one for VA patients. DEA's proposed special registration for telemedicine isn't final yet.
What you can do right now
Three separate federal authorities cover telemedicine prescribing today, and DEA says a practitioner can use the temporary rule even when one of the permanent rules would also apply.
| Authority | What it allows | Key conditions |
|---|---|---|
| Temporary rule (21 CFR 1307.41) | Schedule II through V by telemedicine with no prior in-person evaluation, through December 31, 2026 | Legitimate medical purpose in the usual course of practice; an interactive telecommunications system; a DEA registration covering the drug's schedule; every other DEA prescription rule |
| Buprenorphine rule (21 CFR 1306.51) | Schedule III through V medications approved for opioid use disorder, including by audio-only | An initial supply of up to six months, a check of the state prescription drug monitoring program, and patient identity checks |
| VA rule (21 CFR 1306.52) | Prescribing to VA patients by VA practitioners | Another VA practitioner has seen the patient in person at some point |
What happens after December 31, 2026
Unless DEA and HHS extend the temporary rule again or finalize a permanent replacement, the default under the Ryan Haight Act returns: a practitioner generally has to see a patient in person at least once before prescribing a controlled substance by telemedicine, unless a statutory exception applies. DEA itself calls this the telemedicine cliff. Once a practitioner has seen a patient in person, the Act's remote prescribing limits no longer apply to that relationship, so patients you've already evaluated in person aren't affected. The buprenorphine and VA rules stay in place either way.
What to watch
The main open question is DEA's special registration for telemedicine, proposed on January 17, 2025 (90 FR 6541), which drew more than 6,400 comments. It would let registered practitioners prescribe to patients they've never seen in person, with added recordkeeping and reporting. The federal regulatory agenda lists it at the final rule stage. See the agenda entry. Whatever DEA does next, this page will show it with the citation, usually within a month.
Timeline
| Date | What changed | Citation |
|---|---|---|
| October 15, 2008 | Ryan Haight Act becomes law, requiring at least one in-person evaluation before a controlled substance is prescribed over the internet, with specific exceptions | Pub. L. 110-425 |
| March 25, 2020 | DEA letters let practitioners prescribe by telemedicine without an in-person evaluation during the COVID-19 public health emergency | not FR (DEA letters) |
| March 1, 2023 | DEA and HHS propose two permanent rules; comments close March 31, 2023 | 88 FR 12875; 88 FR 12890 |
| May 10, 2023 | First temporary extension of the flexibilities | 88 FR 30037 |
| October 10, 2023 | Second temporary extension, through December 31, 2024 | 88 FR 69879 |
| November 19, 2024 | Third temporary extension, through December 31, 2025 | 89 FR 91253 |
| January 17, 2025 | DEA proposes a special registration for telemedicine | 90 FR 6541 |
| January 17, 2025 | Final rule allowing buprenorphine for opioid use disorder by telemedicine, with limits | 90 FR 6504 |
| January 17, 2025 | Final rule on telemedicine prescribing for VA patients | 90 FR 6523 |
| February 19, 2025 | Both final rules' start dates delayed to March 21, 2025 | 90 FR 9841 |
| March 24, 2025 | Both final rules' start dates delayed again, to December 31, 2025 | 90 FR 13410 |
| December 31, 2025 | Fourth temporary extension, through December 31, 2026; the buprenorphine and VA rules take effect December 31, 2025 | 90 FR 61301 |
State law still applies
Every federal authority above requires that prescribing also follow state law, and many states set their own telemedicine and controlled-substance rules. Licensure and prescribing follow where the patient is physically located. Check the medical board and pharmacy board rules in each state where your patients are.
Frequently asked questions
Can psychiatrists prescribe controlled substances by telemedicine in 2026?
Yes, under a temporary federal rule that runs through December 31, 2026. A DEA-registered practitioner can prescribe Schedule II through V medications by telemedicine without an in-person evaluation if the prescription is for a legitimate medical purpose, uses an interactive telecommunications system, and meets DEA's other prescription rules. State law still applies and can be stricter.
When do the DEA telemedicine flexibilities expire?
At the end of December 31, 2026, under the fourth temporary extension (90 FR 61301). DEA could extend them again or replace them with a permanent rule before then.
What happens if the flexibilities expire without a new rule?
The Ryan Haight Act's default returns: prescribing a controlled substance by telemedicine generally requires at least one prior in-person evaluation, unless one of the statute's exceptions applies. DEA calls this the telemedicine cliff. The permanent rules for buprenorphine and for VA patients would still apply.
Is the DEA special registration for telemedicine final?
Not as of September 29, 2026. DEA proposed it on January 17, 2025 (90 FR 6541). The federal regulatory agenda lists it at the final rule stage.
Can buprenorphine for opioid use disorder be prescribed by telemedicine?
Yes. A final rule in effect since December 31, 2025 allows Schedule III through V medications approved for opioid use disorder by telemedicine, including audio-only, for an initial six-month supply, with a check of the state prescription drug monitoring program first.
How we keep this current
We check the Federal Register, DEA, and HHS every month for new telemedicine rules, extensions, and delays, and we update this page with the date and citation when anything changes. Every entry links to the primary document. This is education about the rules, not legal advice.
Cite as: Refai S. Telemedicine controlled-substance prescribing tracker. shrinkiatry; last checked September 29, 2026. https://shrinkiatry.com/tools/telemedicine-controlled-substance-tracker/
Sources
- 21 U.S.C. 829(e) and 802(54). uscode.house.gov
- DEA and HHS. Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities, 90 FR 61301. federalregister.gov
- 21 CFR 1306.51. ecfr.gov
- Every rule in the timeline links to its Federal Register document.
Reviewed by Shariq Refai, MD, MBA, FAPA, a board-certified psychiatrist. Last reviewed September 29, 2026.
Go deeper
Read why controlled substances are different and download the telemedicine prescribing rules explainer.