DEA Rules for Prescribing Controlled Substances via Telehealth: Business Guide

The DEA has advocated for telehealth since the COVID-19 pandemic and has made numerous revisions to its rules to accommodate facilities in providing behavioral health services. However, when telehealth intersects with the prescribing of controlled substances, the regulatory environment becomes significantly more complex. 

It is essential for behavioral health businesses to stay compliant with DEA requirements, especially when prescribing controlled substances through telehealth. An advisory firm such as Strategique Partners helps your business stay ahead of regulatory changes to ensure compliance.

Are you interested in ensuring that your behavioral health practice is compliant with DEA regulations? If yes, you can easily get help for compliance management from experts at Strategique Partners!

DEA Compliance Rules for Your Behavioral & Mental Health Business

For behavioral and mental health providers, DEA compliance in telehealth prescribing usually comes down to one operational question: Has the patient received a qualifying in-person medical evaluation?

These two scenarios present different compliance guidelines for behavioral health facilities and practitioners.

If the Patient Has Had An In-Person Session Before

According to the DEA, those cases where the patient has had an in-person session with a medical professional do not need verifications for prescribing controlled substances. Healthcare professionals are allowed to prescribe medication indefinitely to such patients as long as it is medically necessary.

If the Patient Has Not Had an In-Person Session

For cases where the patient has not had an in-person session and examination at the behavioral health facility, they can be prescribed controlled substances via telehealth by following some rules, such as:

1. The Prescribing Medical Professional Must Be Registered with the DEA

Medical professionals who are prescribing medications through telehealth need to be registered with the DEA and have active licenses to prescribe drugs Schedule II-V. 

2. Medical Purpose For Issuing Medications Must Be Justified

The prescription should indicate that the use of the specific controlled medicine was a medical necessity and include follow-ups to justify continued treatment.

3. The Prescriber Must be Licensed in The State of the Patient’s Residence

It is essential for the prescriber to be licensed in the state of the patient’s residence to ensure compliance and prescriptions according to the state law as well.

4. Compliance With the Controlled Substances Act (CSA) is Mandatory

All prescriptions for controlled substances through telehealth modality must be in accordance with the Controlled Substances Act (CSA) and any new requirements.

5. A Physical Examination May Be Asked For At a Later Date

Depending on the case, a physical examination at a later date may be deemed necessary for continued use of the prescription medication. 

6. Proper Medical Records For The Patient Must Be Created & Maintained

Patients who are being prescribed controlled substances via telehealth have to be in the treatment center’s database with updated electronic health records and follow-ups.

7. There Must Be Increased Security Measures For Accessing the Prescription

Behavioral health facilities must have security measures to protect prescriptions and ensure access to only the patient to avoid misuse of the controlled substance.

What is the DEA’s Authority Over Controlled Substance Prescribing?

The U.S. Drug Enforcement Administration (DEA) enforces the Controlled Substances Act (CSA), which is responsible for regulating the prescription of medications classified as Schedule II, Schedule III, Schedule IV, and Schedule V. 

The practitioners at your behavioral health facility need to have an active DEA registration and adhere to strict standards of patient evaluation, recordkeeping, and diversion prevention to justify the prescription of controlled substances. 

For the last decade alone, the DEA enforced the Ryan Haight Act to limit the online prescription of medication, which limited the applications of telehealth. However, in 2025, the DEA became more flexible with online prescriptions as long as practitioners met the strict criteria. 

How COVID-19 Flexibilities and Temporary DEA Waivers Affect Your Business?

To address the long-term challenges faced during the COVID-19 and post-COVID era, the DEA proposed a new framework that laid down the guidelines for your behavioral health business. It gave businesses like yours the option to forgo the initial in-person visit required for prescribing controlled substances if the particulars of the case met their criteria.

This is leading to the development of a permanent framework  that includes:

• A Telemedicine Prescribing Registration allowing Schedule III–V prescribing via telehealth.
• An Advanced Telemedicine Prescribing Registration permitting Schedule II–V prescribing for specific, highly regulated medical specialties.
• Potential registration requirements for telehealth platforms that facilitate controlled-substance prescribing

DEA also regularly updates its frameworks to allow ease in providing medically-assisted healthcare services. As of November 10th, 2025, it has granted a fourth temporary extension of COVID-19 telemedicine flexibilities. 

How to Prepare For the Post-2025 Telehealth Prescription Era

Having a successful behavioral health business means complying with DEA requirements and updated regulations. The relaxations offered to prescribers in telehealth modality will continue until 2026, until new changes are made, yet the DEA still has mechanisms in place to ensure proper use of controlled substances.

As a business, you can prepare for the post-2025 era by maintaining interoperable and HIPAA-compliant patient databases to track telehealth treatments and the use of medications. Ensure your systems are updated with technological changes so when a new set of instructions arrives from the DEA, your business can continue with compliance without using extra resources. 

Strategique Partners Helps Your Behavioral Health Business Stay Compliant with DEA Rules

Staying up-to-date with DEA rules and regulations is essential for any thriving behavioral health business. Strategique Partners offers expert operational services that oversee regulation and compliance.

We help your behavioral health business adhere to DEA guidelines through:

• Regulatory compliance assessments
• Accreditation assistance
• Ongoing compliance monitoring
• Licensing support
• Audit preparation & support
• Policy and procedure development

Looking to get expert help with DEA compliance? Strategique Partners will help you stay true to your business goals while ensuring adherence to rules and regulations.

Commonly Asked Questions about DEA Rules for Prescribing Controlled Substances Via Telehealth

What Are the Requirements for a Controlled Drug Prescription?

According to the DEA, controlled drug prescriptions should only be carried out by registered medical professionals who are treating a patient within their state, with complete records and a medical necessity for the medication.

Can Controlled Substances Be Prescribed by Medical Professionals Outside of the State?

No, the DEA requires practitioners and prescribers to be registered in the state of the patient to whom they are prescribing controlled substances.

What Is the 7-Day Rule for Telemedicine?

The 7-day telemedicine rule states that short encounters of 5 to 20 minutes within 7 days of an evaluation or telehealth session should not be billed separately, even if medications were prescribed and they were taken as a follow-up.

Can Opioid Addiction Treatment Medications Be Prescribed Through Audio-Only Sessions?

No, the DEA has made it a requirement since March 2025 that buprenorphine cannot be prescribed to patients through audio-only sessions. Now, all prescriptions should be made after audio-video sessions that are mandatory.