DEA Telehealth Rule Extension: Understanding the 2026 Landscape

By Jocelyn Jaime | Blog, Rural | 0 comment | 10 December, 2025 | 0

December 10, 2025

By Jocelyn Jaime, MA

Project Coordinator, California Telehealth Resource Center

Why This Matters

Telehealth prescribing rules for controlled substances are shifting—and the stakes are high. These changes affect patient access, opioid use disorder treatment, and compliance risk for clinicians. Understanding the timeline and differences between Schedule II–V and Buprenorphine prescribing is critical to avoid disruptions in care and regulatory penalties.

Key Questions for Clinicians

- Which controlled substances can you prescribe via telehealth?
- Is an in-person visit required before telehealth prescribing?
- Can audio-only telehealth be used?

These questions don’t have a single answer—they depend on when you’re prescribing. Let’s break down the rules by era to see how requirements have shifted and what’s coming next.

Timeline: Pre-Pandemic Era (Before 2020)

This period set the strict baseline for telehealth prescribing under the Ryan Haight Act. The goal was to prevent misuse and ensure patient safety.

- Schedule II–V: In-person medical evaluation was required before any telehealth prescribing. Interactive audio-video was allowed only after the first in-person visit. Audio-only was not permitted.
- Buprenorphine: Same restrictions applied—no audio-only allowed.

Timeline: Pandemic Era (Through Dec 31, 2025)

COVID-19 triggered emergency flexibilities to maintain access to care during lockdowns. These changes dramatically expanded telehealth prescribing options.

- Schedule II–V: Prescribing was allowed via interactive audio-video telehealth without an initial in-person visit.
- Buprenorphine: Audio-only telehealth was permitted for opioid use disorder treatment.

Timeline: Post-Pandemic Rules (Starting Jan 1, 2026)

Unless extended, the Ryan Haight Act’s original safeguards return, tightening requirements and introducing grace periods for buprenorphine patients.

- Schedule II–V: An in-person visit will be required before telehealth prescribing resumes.
- Buprenorphine: Patients starting via telehealth will have a six-month grace period to complete an in-person visit. After that, an in-person evaluation is mandatory. Audio-video remains authorized, but audio-only will be limited to buprenorphine only.

Special Note on Buprenorphine:

- Existing patients: must complete in-person visit within 6 months of Jan 1, 2026
- New patients: in-person visit within 6 months of first telehealth appointment
- After grace period: prescriptions require in-person evaluation or meet a Ryan Haight exception

Possible Extensions

A fourth extension of pandemic-era flexibilities is under review by the Office of Management and Budget. If approved, current rules may continue beyond Dec 31, 2025.

Final Thoughts

The Ryan Haight Act remains the foundation for telehealth prescribing. Pandemic-era flexibilities expanded access temporarily, but clinicians should prepare for stricter requirements in 2026—while monitoring for possible extensions.

References: