On December 31, the Drug Enforcement Administration and the Department of Health and Human Services issued an extension of the temporary rule that’s been making buprenorphine, a critical medication for opioid use disorder (MOUD), more accessible. It would otherwise have expired the same day.
This is the fourth temporary extension and will expire in one year—a time frame comparable to the previous extensions, and one the DEA feels is short enough that it will not, amid an ongoing opioid-involved overdose crisis, risk the public gaining too much access to lifesaving medication.
Since 2008, an amendment to the Controlled Substances Act had barred patients from receiving prescriptions for controlled substances via telemedicine alone, requiring that they first attend at least one appointment with a provider in person. This was a particularly high barrier for bupe, which is under Schedule III, for a number of reasons, including the medical field’s overwhelming hostility toward people with opioid use disorder.
In March 2020, when the COVID-19 pandemic made in-person appointments a public health risk, the DEA granted temporary exceptions to the requirement that specifically cleared providers to prescribe bupe to patients they spoke with on the phone, even without a video component. This temporary rule was extended to late 2023, then extended a second time to late 2024, and then a third time to December 31, 2025.
This extension will last until the end of 2026, in an effort to forestall what the DEA refers to as the “telemedicine cliff.”
Now, the fourth temporary extension will take effect January 1, 2026 and last until the end of the year, to forestall what the DEA refers to as the “telemedicine cliff”: patients who’d been receiving medication from providers they hadn’t met in person being abruptly cut off when the temporary exception finally expired and no permanent rule had replaced it. This would not only disrupt lifesaving treatment for many patients, but would overwhelm providers with a backlog of requests for in-person evaluations.
“DEA has received numerous communications from patients, providers and other stakeholders warning that expiration of the current telemedicine flexibilities, without further regulation, could potentially and abruptly limit patients’ access to care until promulgation of a final set of regulations,” the agency wrote in its new temporary rule. “The potential harms are widespread. To put it into context, one stakeholder summarized unpublished data reviewed by Epic, Johns Hopkins, and Stanford: of an estimated 44.6 million prescriptions for controlled substances prescribed across 258 organizations in 2024, more than 7 million, approximately 16 percent, were issued without a prior in-person medical evaluation.”
In January, the DEA issued a separate final rule that further expanded telehealth bupe access, clearing providers to prescribe bupe to new telehealth patients for up to six months even if they hadn’t met for an initial in-person appointment. But before the rule actually went into effect, President Donald Trump was inaugurated and all federal rulemaking was suspended. The deadline for implementation was pushed back to February, then March, then finally to December 31. As the now-permanent rule for buprenorphine obviously has a lot of overlap with the newly extended temporary rule for all controlled substances, prescriptions will be considered compliant as long as they fall in line with either of them.
A recent JAMA Psychiatry study estimated that from 2019 to 2020, the portion of United States outpatients who accessed mental health services via telemedicine went from 0.4 percent to 46.1 percent. Between 2021 and 2022, one out of every four US outpatients accessed mental health services via telemedicine. The same study found that compared to other patients, those prescribed bupe were less likely to receive any kind of telemedicine mental health care services.
Image via National Cancer Institute
