DEA Permanently Expands Telehealth Access for Buprenorphine Prescribing Without Initial In-Person Visit

The Drug Enforcement Administration has made permanent a series of telehealth flexibilities initially introduced during the COVID-19 pandemic, fundamentally changing how providers can prescribe buprenorphine and other medications for opioid use disorder treatment.

Three new rules announced last month mark the most significant expansion of telemedicine prescribing authority for controlled substances in decades. The changes, which took effect February 18, 2025, eliminate longstanding barriers that required in-person evaluations before prescribing addiction treatment medications—a requirement many experts argued unnecessarily delayed access to life-saving care.

The Core Change: Audio-Only Buprenorphine Prescribing

The most impactful rule permits qualifying healthcare providers to prescribe up to a six-month initial supply of Schedule III-V medications, including buprenorphine, through audio-only telehealth appointments. Previously, federal law required an initial in-person examination before any controlled substance could be prescribed via telemedicine.

Buprenorphine, marketed under brand names including Suboxone and Sublocade, is one of three FDA-approved medications for treating opioid use disorder. It reduces cravings and withdrawal symptoms while blocking the euphoric effects of other opioids, allowing people to stabilize their lives while engaging in comprehensive recovery support.

The medication's effectiveness is well-established. Multiple studies have shown that medication-assisted treatment significantly reduces overdose deaths, improves treatment retention, and helps people return to work and family responsibilities. Yet access has remained inconsistent, particularly in rural areas with limited addiction medicine specialists.

Under the new rule, patients can initiate buprenorphine treatment through a phone call with a qualified provider, receive a prescription sent directly to their local pharmacy, and begin treatment the same day. After six months, federal law requires an in-person evaluation for continued prescriptions, though that requirement may be met by any qualified provider, not necessarily the original prescriber.

Who Can Prescribe Under the New Rules

Not all healthcare providers automatically gain expanded prescribing authority. The DEA's rules impose specific requirements:

DEA registration. Providers must maintain current DEA registration and comply with all federal controlled substance regulations.

Prescription Drug Monitoring Program review. Before prescribing, clinicians must check their state's PDMP database to review the patient's controlled substance history. The date and time of this review must be documented in the patient's medical record.

State law compliance. The federal rules establish a floor, not a ceiling. States may impose additional restrictions on telehealth prescribing, and providers must comply with whichever standard is stricter. Several states, including Ohio, maintain tighter buprenorphine limits than the new federal framework allows.

Clinical judgment and documentation. Providers must conduct appropriate clinical assessments via telehealth, maintain thorough patient records, and document the rationale for prescribing decisions just as they would for in-person care.

Veterans Affairs Exemptions

A second final rule creates specific flexibilities for Department of Veterans Affairs providers treating veterans with substance use disorders. VA practitioners can now prescribe controlled substances via telemedicine without an initial in-person evaluation if the patient was previously evaluated by any VA practitioner—not necessarily the prescribing provider.

Additionally, VA healthcare workers are exempt from special telemedicine registration requirements that apply to non-VA providers. This exemption recognizes the VA's integrated healthcare system and aims to ensure veterans maintain uninterrupted access to addiction treatment medications when transitioning between providers or locations.

The rule includes the same PDMP review and documentation requirements that apply to non-VA providers, maintaining safeguards against diversion and misuse while expanding access.

The Proposed Special Registration Framework

The DEA also released a proposed rule outlining a future registration system for telehealth providers and platforms. While not yet finalized, this framework signals the agency's long-term vision for regulating virtual controlled substance prescribing.

The proposal introduces three registration categories:

Telemedicine Prescribing Registration. Physicians and mid-level practitioners with this registration could prescribe Schedule III-V medications remotely without requiring the Ryan Haight Act's in-person examination. This registration would formalize and expand upon the buprenorphine-specific flexibility already established.

Advanced Telemedicine Prescribing Registration. Specialists including psychiatrists, hospice physicians, pediatricians, and neurologists could qualify for authority to prescribe Schedule II-V medications via telemedicine. This category recognizes that certain medical situations require more potent controlled substances that would otherwise require in-person visits.

Telemedicine Platform Registration. Online platforms that connect patients with prescribers could obtain registration allowing their affiliated providers to prescribe Schedule II-V medications. To qualify, platforms must meet specific criteria related to their business model, financial interests in prescribing volume, and control over clinical decision-making.

The DEA is accepting public comments on this proposed framework through March 18, 2025. If finalized—likely not before 2026—the special registration system would create clearer pathways for multi-state telehealth practice while maintaining federal oversight of controlled substance prescribing.

State-Level Complications

While the federal rules expand what's permissible under DEA regulations, they don't preempt state law. Healthcare providers must navigate a complex patchwork of state requirements that vary significantly:

Some states have embraced telehealth prescribing with minimal restrictions, viewing it as essential for addressing provider shortages and geographic access barriers. Others maintain stringent requirements for in-person examinations, visit frequency, or prescription quantities that effectively limit or prohibit audio-only buprenorphine initiation.

This creates practical challenges for patients and providers. Someone living in a state with restrictive telehealth laws may not be able to access the expanded federal flexibilities, even though DEA regulations technically permit it. Providers practicing across multiple states must track varying requirements and adjust their protocols accordingly.

Healthcare attorneys and telehealth advocates have called for greater state-federal alignment, arguing that inconsistent rules create unnecessary barriers to evidence-based treatment. Whether states will harmonize their regulations with the new federal framework remains an open question that will unfold over the coming months and years.

Clinical and Ethical Considerations

The expanded telehealth authority raises important questions about maintaining quality care in virtual settings. Audio-only visits, while more accessible than video appointments, provide clinicians with less information than in-person examinations. Providers cannot observe physical signs of intoxication, withdrawal, or other medical conditions that might inform treatment decisions.

Professional medical organizations have issued guidance emphasizing that telehealth prescribing, while permissible, must meet the same standard of care as in-person treatment. This includes:

• Establishing a legitimate provider-patient relationship
• Conducting thorough clinical assessments appropriate to the telehealth modality
• Educating patients about medication risks, side effects, and proper use
• Developing safety plans for overdose risk and medical emergencies
• Coordinating with local healthcare resources when needed
• Maintaining appropriate documentation

Providers also must be attuned to patients who may be attempting to obtain medications for diversion or misuse rather than legitimate treatment. While buprenorphine has lower overdose risk than full opioid agonists, it still carries potential for misuse, and unscrupulous individuals may exploit telehealth systems to obtain medications they intend to sell.

Balancing access with appropriate safeguards represents the central tension in telehealth policy. The DEA's rules attempt to strike that balance by removing unnecessary barriers while maintaining PDMP review requirements, visit documentation standards, and eventual in-person evaluation mandates.

Research Evidence on Telehealth Outcomes

Data collected during the pandemic provides reassuring evidence about telehealth-initiated buprenorphine treatment. A 2025 study published in the American Journal of Psychiatry examined nearly 8,000 patients and found that telehealth initiation did not increase the overall risk of subsequent substance use disorder compared to in-person initiation.

Other research has demonstrated that retention in treatment—one of the strongest predictors of long-term recovery—remained comparable between telehealth and in-person buprenorphine programs. Patients appreciated the convenience and reduced stigma of virtual appointments, while providers noted that telehealth allowed them to reach populations who previously faced transportation, work schedule, or childcare barriers to accessing in-person care.

These findings informed the DEA's decision to make pandemic flexibilities permanent rather than allowing them to expire.

Impact on Rural and Underserved Communities

The practical significance of these rule changes may be greatest in rural America, where opioid use disorder prevalence remains high but addiction medicine specialists are scarce. Many rural counties have no providers with DEA waivers to prescribe buprenorphine, forcing residents to travel hours for treatment or go without.

Audio-only telehealth eliminates geographic constraints. A patient in rural Montana can now connect with a qualified provider anywhere in the state (or in another state, depending on licensure) and receive a prescription without leaving their community. This dramatically expands the effective treatment network.

The same logic applies to medically underserved urban areas, tribal communities, and populations facing stigma or discrimination in traditional healthcare settings. By reducing the logistical burden of accessing treatment, telehealth may help more people initiate and sustain recovery during the critical early months when dropout rates are highest.

What Providers Need to Do Now

Healthcare practitioners who wish to prescribe buprenorphine via telehealth under the new rules should take several steps:

1. Verify state law compliance. Check whether state regulations permit audio-only buprenorphine prescribing and what additional requirements may apply.

2. Ensure DEA registration currency. Confirm that DEA registration is active and includes the appropriate schedules.

3. Establish PDMP review protocols. Develop workflows for checking state prescription monitoring databases before each new prescription and documenting reviews in patient records.

4. Update consent forms. Revise patient intake materials to address telehealth-specific issues, including technology requirements, emergency procedures, and the six-month in-person evaluation requirement.

5. Train staff. Ensure administrative personnel understand new procedures for scheduling telehealth appointments, verifying patient identity, and coordinating pharmacy communication.

6. Review malpractice coverage. Confirm that professional liability insurance covers telehealth services across all states where the provider is licensed.

Looking Ahead

The DEA's rules represent a significant step toward integrating telehealth into routine addiction treatment, but they're unlikely to be the final word. As the proposed special registration framework develops and states respond to federal changes, the regulatory landscape will continue evolving.

Advocacy groups have called for additional reforms, including elimination of the six-month in-person requirement and expansion of telehealth authority to cover methadone, which currently requires daily in-person dosing except in highly restricted circumstances. Whether federal agencies will move in that direction depends on both clinical evidence and political considerations surrounding controlled substance regulation.

For now, the immediate impact is clear: tens of thousands of people who previously could not access buprenorphine treatment due to geographic, logistical, or provider availability constraints can now initiate recovery through a phone call. In the context of an ongoing overdose crisis that claimed more than 70,000 American lives in the 12 months ending September 2025, removing barriers to evidence-based treatment represents meaningful progress.

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For information about accessing medication-assisted treatment for opioid use disorder, contact the SAMHSA National Helpline at 1-800-662-4357. The service is free, confidential, and available 24/7.