Outpatient Opioid Prescribing During COVID-19

Prior to COVID-19, the Drug Enforcement Agency (DEA) specified that in order to prescribe controlled substances via telemedicine, a health care provider must have met the patient in person or via video/audio communication in a DEA-registered facility.

During COVID-19, the DEA has authorized an exception allowing prescription of controlled substances based on a telemedicine visit without a prior in-person or telemedicine visit in a DEA-registered facility.

The key component and major limitation to these exceptions is the definition of telemedicine, which requires using an "audio-visual, real-time, two-way interactive communication system.” Telephone-only communications are not allowed as part of the DEA exceptions.

• Allows DEA-registered practitioners to begin issuing prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation
• Allows DEA-registered practitioners to continue this telemedicine practice until the crisis is over
• Requirements:
  • The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice
  • The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system
  • The practitioner is acting in accordance with applicable federal and state law

This algorithm is adapted from the DEA's How to Prescribe Controlled Substances to Patients During the COVID-19 Public Health Emergency.

Has the patient previously been seen (in person) in a DEA facility?

If yes...

• The practitioner may conduct any needed follow-up evaluation by an method (e.g., in person, via telehealth, telephone, or email)
• The practitioner may issue any needed prescription(s) directly to the patient or pharmacy

If no...

• The practitioner should evaluate the patient via telehealth using a real-time, two-way, audio-visual communications device
• The practitioner may issue any needed prescription(s) directly to the patient or pharmacy

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