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.

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

Opioid Prescribing Algorithm

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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