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With DEA Telemedicine Prescribing Flexibilities Set to Sundown at the End of This Year, What's Next?

  • Writer: Beverly Johnson
    Beverly Johnson
  • Nov 17
  • 4 min read

tech using an emr system-electronic medical records - advanced practice partners

The DEA telemedicine prescribing flexibilities for controlled substances, which lifted the requirement for an initial in-person appointment, are set to expire at the end of this year.

But without an alternate permanent pathway for telemedicine-controlled substance prescribing, state medical boards and local DEA offices continue enforcing rigid, outdated, and non-medically necessary in-person location requirements. And providers are left wondering what will happen to the regs after December 31, 2025.

Despite the DEA telemedicine prescribing flexibilities which formally suspended the requirement for in-person appointments, the Rhode Island and Alabama state medical boards both still require an in-person provider visit prior to initiating a controlled substance. This directly contradicts the federal DEA guidance. If you think providers are confused, you’re right.

To meet Alabama’s in-person visit requirement, Bicycle Health-a multi-state healthcare organization that provides life-saving medication treatment for Opioid Use Disorder- initially flew teams of doctors to the rural southeast state two years in a row. When this became logistically and financially unsustainable, Bicycle Health was forced to pull out of Alabama altogether, leaving thousands of patients without life-saving addiction treatment.

Not surprisingly, Bicycle Health and similar addiction treatment providers like Aware Recovery Care are also unable to provide virtual only medication services in Rhode Island due to the state’s in-person visit requirement-this during a time in our nation’s history when untreated addiction kills over 116,000 Americans each year. For comparison, this is the same amount of people who died in World War One and double the amount that died in the Vietnam War.


Equally confusing, rather than loosening in-person provider requirements to align with the current federal DEA telemedicine extension, state and local DEA offices are now making in-person provider documentation requirements stricter. As recently as a few months ago, most provider applications for an initial DEA simply asked you to list the physical address of your practice location. In addition to that, DEA now requires that you also present a rental agreement that indicates you (the provider) are indeed the tenant of the proposed registered location and proof in the agreement that the rented space is a private office setting.

So on paper the DEA has officially extended COVID era telemedicine flexibilities through the end of 2025. But in practical everyday terms, they have made it almost impossible to provide multi-state telemedicine-based addiction care. This during a time when twice as many Americans are dying from untreated addiction each year than died in the entire Vietnam War.

The increasingly strict DEA in-person location requirements are a well-meaning but misdirected reaction to the well-publicized scandals at Cerebal and Done-two large ADHD telemedicine companies that tweaked patient appointment algorithms to favor profit over patient safety and clinical quality.


While unfortunate, the COVID telemedicine changes did not create the Cerebal and Done debacles. Human greed created this.

Prioritizing profit over provider autonomy and evidence-based medicine led to this. Cerebral and Done both created leadership cultures that pressured providers to prescribe more stimulants. This pressure can (and does) occur at any organization that priotitizes profit over patient care-whether it provides in-person or virtual treatment. We are seeing the same challenges unfold in the for-profit GLP-1 prescribing space, where everybody with a pulse is prescribed a compounded semaglutide.


There is also some concern that telemedicine evaluations will increase the rate of stimulant addiction and stimulant use disorder. However, a multi-center study completed and published last year in the Journal of the American Academy of Child and Adolescent Psychiatry showed no difference in the rate of development of stimulant use disorder between telemedicine and in-person medication initiated appointments.


While telemedicine is an easy and convenient villain to blame for the rise in healthcare profit over patient safety, its more complicated than that. The truth is far more nuanced. Making telemedicine impractical for the millions of well-meaning and well-trained autonomous providers who treat addiction does not solve the problem-it worsens it.


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Enacting and enforcing legislation that separates, insulates, and protects evidence-based healthcare provider decisions from business interests gets to the heart of the issue. Existing Corporate Practice of Medicine (CPO) laws that currently regulate this important distinction are not present in all states and are rarely enforced.


Additionally, supporting mid-level providers with experienced, trained autonomous physician leaders who follow evidence-based guidelines and prioritize patient safety over profit is also key. This will help pull the human greed weed up by the root, instead of cutting away at its more visible but misleading leaves. To support this end, The American Professional Society of ADHD and Related Disorders is set to release national, uniform, evidence-based guidelines for the diagnosis and treatment of ADHD at the end of 2025.


While a few bad actors have used telemedicine as an avenue to expand corporate greed, the vast majority of American medical providers utilize telemedicine to provide life-saving addiction and psychiatric treatment to those who would otherwise never receive care. In-person travel requirements disproportionally affect minority and underserved communities where this care is needed most.


Let’s hope that the DEA uses the remaining few months of 2025 to codify a thoughtful, reasonable, permanent telemedicine prescribing solution- a long-term answer that protects the life-saving access to care that telemedicine offers, while ensuring that healthcare decisions are driven by evidence-based data instead of dollar signs.

Both Are Possible.


-Lauren Grawert




© 2025

 
 
 
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