Upcoming Changes in Controlled Substance Prescribing and Telemedicine

Apr 4, 2023 | Health & Prevention, Laboratory News, Medical

On February 24, 2023, the Drug Enforcement Administration (DEA) announced in a press release the proposed permanent rules for the prescribing of controlled medications via telemedicine, expanding patient access to critical therapies beyond the scheduled end of the COVID-19 public health emergency.1

The proposed rules – developed with the U.S. Department of Health and Human Services and in close coordination with the U.S. Department of Veterans Affairs – propose to extend many of the flexibilities adopted during the public health emergency with appropriate safeguards.1

“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.” 1

The proposed rules do not affect:

  • Telemedicine consultations that do not involve the prescribing of controlled medications
  • Telemedicine consultations by a medical practitioner that has previously conducted an in-person medical examination of a patient
  • Telemedicine consultations and prescriptions by a medical practitioner to whom a patient has been referred, as long as the referring medical practitioner has previously conducted an in-person medical examination of the patient.1

The proposed rules would provide safeguards for a narrow subset of telemedicine consultations—those telemedicine consultations by a medical practitioner that has: never conducted an in-person evaluation of a patient; AND that result in the prescribing of a controlled medication. For these types of consultations, the proposed telemedicine rules would allow medical practitioners to prescribe:

  • a 30-day supply of Schedule III-V non-narcotic controlled medications
  • a 30-day supply of buprenorphine for the treatment of opioid use disorder. 1

If implemented, these new rules would end pandemic-era telemedicine exceptions, which currently allow authorized medical professionals to prescribe Schedule II narcotics and stimulants (ie, fentanyl, methadone, oxycodone, dextroamphetamine, methylphenidate, methamphetamine) via telehealth without an initial in-person evaluation.2

Since the new guidelines will require an in-person patient visit after an initial 30-day supply of buprenorphine via telemedicine, there is concern about treatment interruptions or increasing barriers to treatment access and the impact on patients in recovery. Studies indicate that telehealth services have improved addiction treatment access and outcomes, with telehealth services, more patients are staying in treatment with fewer overdose incidents.2

However, the reinstatement of in-person visit requirements for controlled substance prescriptions may present barriers for patients with transportation challenges, such as patients with disabilities or those with limited geographic healthcare access.2

The dynamic nature of modern healthcare -whether it is in person, or via telehealth- requires that all care provided is adaptable, dependable, and consistent.

At Genesis Reference Laboratories, we provide superior laboratory services with a customer service focused approach that provides our clients peace of mind that they are supported at all times. Our panels are customizable to allow providers the ability to choose what tests they want or do not want from our extensive menus. In providing this ordering format, healthcare providers may tailor laboratory testing to address the specific needs of each patient.

In regard to the proposed telehealth and prescribing guidelines, we offer extensive urine and oral fluid toxicology testing to aid in monitoring prescribed adherence. This includes the identification and quantification of buprenorphine as well as commonly prescribed schedule II medications, such as opioids and medications used to treat ADHD. Additionally, our drug toxicology services aid in the ability to detect unprescribed medications and illicit substances. This can help practitioners identify recent substance abuse, even if the patient is not impaired when the sample is collected for drug testing.


  1. https://www.dea.gov/press-releases/2023/02/24/dea-announces-proposed-rules-permanent-telemedicine-flexibilities
  2. https://www.practicalpainmanagement.com/news/dea-proposes-rules-to-limit-telehealth-prescribing-of-certain-controlled-medications