BRIDGE Prescribing by Telemedicine Updates to Controlled Substance Regulations

In general, under 21 U.S.C. 829(e), a valid prescription for a controlled substance requires a practitioner to have conducted at least one in-person medical evaluation of the patient. However, during a declared public health emergency (PHE), the Department of Health and Human Services and the DEA can implement telemedicine allowances for prescribing controlled substances.

Two recent nationwide PHEs are relevant in understanding current telemedicine allowances:

Opioid PHE. Ongoing; originally declared on October 26, 2017 and last renewed March 25, 2024
COVID-19 PHE. Declared January 31, 2020 and ended March 11, 2023

Telemedicine allowances differ between prescriptions for buprenorphine prescribed to patients with OUD and all other controlled substance prescriptions.

Buprenorphine for OUD

Buprenorphine prescriptions for the treatment of opioid use disorder may be issued via telemedicine by DEA-registered practitioners without the practitioner conducting an in-person medical evaluation of the patient. This allowance originated during the COVID-19 PHE but was transferred to the Opioid PHE on November 30, 2022.

This allowance is in effect for the duration of the opioid PHE.

Telemedicine requires an interactive telecommunications system, which is a two-way, real-time interactive communication between the patient and practitioner using audio and video. Audio-only two-way, real-time interactive communication is allowed for buprenorphine if the patient is not capable of or does not consent to the use of video.

All other state and federal requirements of buprenorphine prescribing must be met, including ensuring prescriptions are issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice.

Read the DEA's letter regarding this allowance for more information.

Other Controlled Substances

All controlled substance prescriptions may be issued via telemedicine by DEA-registered practitioners without the practitioner conducting an in-person medical evaluation of the patient. Although this allowance was originally part of the COVID-19 PHE, the DEA temporarily extended it while they consider permanent regulatory changes.

This allowance is in effect until December 31, 2024.

Telemedicine requires an interactive telecommunications system, which is a two-way, real-time interactive communication between the patient and practitioner using audio and video. Audio-only two-way, real-time interactive communication is allowed only for mental health disorders and when the patient is not capable of or does not consent to the use of video.

All other state and federal requirements of controlled substance prescribing must be met, including ensuring prescriptions are issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice.

Read 21 CFR 1307.41 for more information about the temporary extension.

This page was last updated on May 23, 2024. The information contained herein is not legal advice. Although the P2P team will make every attempt to keep this information updated as telemedicine allowances change, pharmacists are encouraged to refer to the eCFR and guidance documents from the DEA when making dispensing decisions.