Navigating Regulations Regarding the Prescription of Controlled Substances via Telehealth

In this video, filmed at Psych Congress Elevate 2025, Steering Committee Member Edward Kaftarian, MD, walks clinicians through current and forthcoming regulations regarding the prescription of controlled substances via telehealth. In addition to covering how recent state and federal-level changes may impact everyday practice, Dr Kaftarian also provides an overview of the Drug Enforcement Administration (DEA)’s proposed special registration process for controlled substance prescribing via telemedicine. With a focus on staying compliant, Dr Kaftarian covers both what clinicians can expect when the process is finalized, and how to navigate controlled substance prescribing in the meantime. 

For more telehealth insights, visit the Telehealth Excellence Forum.

For more conference coverage, visit the Psych Congress Elevate newsroom.

Read the Transcript

Edward Kaftarian, MD: My name is Dr Edward Kaftarian, I'm a psychiatrist, board certified in forensic psychiatry and addiction medicine, and I'm on the Steering Committee for Psych Congress. I'm also the chairman and CEO of Orbit Health Telepsychiatry.

Psych Congress Network: How have recent changes in federal and state telepsychiatry regulations, particularly regarding controlled substance prescribing, impacted the way clinicians deliver psychiatric care in everyday practice?

Kaftarian: Telehealth law, as we all should know by now, is really dynamic, and it is constantly evolving and changing. We've seen a lot of changes in the last couple years, but not so many changes in the last 6 months or so. There have been states that have adopted more parity laws and consent rules and other matters have been addressed state by state. 

As far as federal laws and rules, particularly when it comes to controlled substances, we're still waiting for the DEA to issue the final rule to have that approved and put in place. Generally, regarding controlled substances, a lot of the COVID-19 pandemic flexibility is still there, but you need to be very careful to watch for what the new rules are going to call for, and so we're all waiting for that to happen. But generally speaking, there hasn't been a whole lot of change in the last 6 months or so.

PCN: In regards to the DEA’s new special registration process, what are the key takeaways for clinicians who prescribe controlled substances via telemedicine, and what practical steps should they take now to stay compliant?

Kaftarian: The special registration process that has been proposed by the DEA has not yet been finalized. We're happy to see that they're working on that because it's been a long time coming. The special registration process, as we understand now, will require a provider who wants to prescribe controlled substances to register in each state where the patient is located. If you want to provide controlled substances to patients in several states, you need to make sure that you have a DEA registration in each of those states. 

You might be thinking, “That's going to get really expensive,” and fortunately the DEA has had some compassion around this—they’re only going to charge $50 per state. That's a definite improvement in what was being proposed earlier where you needed a full registration that would cost almost $900 per state. 

So, it appears that we have a special registration that is going to be finalized soon, and that's going to allow you to prescribe Schedule III through V medications, including buprenorphine for opioid addiction and substance use disorders. As far as Schedule II, for example, opioid medications for pain control as well as stimulants like adderall for ADHD, those Schedule II medications are not going to be included in the regular special registration process—but have no fear, there's going to be an advanced registration. If you can show that there is a definite need for your patients to have controlled substances that are Schedule II, then there's an additional process that you have to go through. 

What I'd recommend and what's required is that before you prescribe any controlled substance, you check with the database that's in your state that shows what kind of prescriptions have been issued to the patient so that you can make sure that the patient isn't doctor-shopping and trying to get as many controlled substances as possible from various doctors. 

But overall, we're very pleased to see that the DEA has come around and is finally issuing a special registration process. We're not yet finalized on that. In the meantime, we have a lot of the flexibilities that are still in place around controlled substances. You can still prescribe it via telehealth, but it needs to be in the course of your practice for a legitimate medical need, and you need to have an appointment with the patient to prescribe that. It doesn't have to be an in-person appointment right now. We're going to see how that unfolds, and I would recommend that whatever you do, make sure that you consult with the appropriate state and federal rules and regulations, because these things are happening very quickly and they're changing dynamically, so what is true today may not be true tomorrow. 

Thank you so much for joining me today. I hope that this was very helpful for your clinical practice.

Edward Kaftarian, MD, is a preeminent authority in the field of Telepsychiatry. He holds a distinguished seat on the Telepsychiatry Committee of the American Psychiatric Association and is a member of the Steering Committee for Psych Congress, the United States' largest independent mental health educational conference. Additionally, Dr Kaftarian is a prominent speaker on the rules and regulations governing telehealth. Dr Kaftarian completed his psychiatry training at the prestigious Johns Hopkins University and holds board certifications in Psychiatry, Forensic Psychiatry, and Addiction Medicine.

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