Behavioral health and addiction treatment providers are expecting renewed guidance from the Drug Enforcement Administration (DEA) around telehealth prescribing flexibilities for controlled substances, now that the longest government shutdown in the country’s history has been resolved.
A pending executive order sent to the Office of Management and Budget titled “Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications” seems to suggest these provisions will be extended for another year. However, its exact details have yet to be released.
Previous telehealth prescribing extensions brought relief and ease to many providers who treat substance use disorders (SUDs), allowing them to more easily prescribe medications like methadone and buprenorphine for treatment without as many barriers.
These flexibilities increased patient access, particularly in rural areas.
While President Donald Trump swiftly passed legislation on Nov. 12 that extended some telehealth provisions through Jan. 30, 2026, not all details have been fleshed out and some are calling for more permanent guidance.
“We are doubling down on our efforts to work with Congress and the administration to secure a permanent solution — or at minimum a years-long extension — for these telehealth waivers,” Kyle Zebley, executive director, ATA Action the advocacy arm of the American Telemedicine Association, said in a statement. “With January 30 fast approaching, now just weeks away, swift action is essential. The clock is ticking, and the uncertainty created by this shutdown still looms large.”
The action delayed the in-person requirement for mental health care to some extent, but did not provide clarity around what will happen after prescribing flexibilities in telehealth expire in December, which is likely what the pending executive order will detail.
Earlier this year, the DEA extended flexibilities to telehealth providers through Dec. 31, 2025, allowing them to prescribe buprenorphine for up to six months without an initial in-person visit, which will test provider readiness. To do this, telehealth providers must register with the DEA to receive a special registration if they wish to provide prescriptions for Schedule III-V or Schedule II substances, which both methadone and buprenorphine fall under.
Medical associations and advocacy groups in the space view the executive order as a positive sign and anticipate that the DEA will extend these flexibilities for another year with minimal changes through December 2026.
“We don’t know what the DEA has included in the final rule, but are hopeful this will be a clean extension of the flexibilities for another year,” a spokesperson for the American
Telemedicine Association told Behavioral Health Business.
It was exactly one year ago when the DEA extended some of these flexibilities. With the shutdown lifted, providers are hoping for revisions soon, as many have already grappled with complications brought on by the shutdown.
“This pending executive order about prescriber rules will impact how clients can access care,” Dana Colthart, psychotherapist at Clear Light Therapy, a mental health clinic in New Jersey, told BHB. “Right now, things are still pretty flexible because we are still operating under a temporary COVID era that allows people to access psychiatric medication more freely and easily, these rules expire soon. I am not a prescriber myself, but do work with patients one-on-one in a therapeutic capacity. It sounds like there may be tighter standards for those who prescribe.”
When the government shutdown began on Oct. 1, several key telehealth policies first put in place during the COVID-19 pandemic expired without resolution. Alongside that, a freeze on Medicare claims dated Oct. 1 and beyond temporarily paused reimbursement for SUD providers. These factors temporarily strained resources for some and have prevented long-term planning for others, as updates to telehealth rules and prescribing regulations have been challenging to predict since then.
Once the DEA shares details about the fourth extension, it will at least allow providers to operate and plan forward until more permanent frameworks around telehealth rules and prescribing are established in time.
BHB contacted the DEA, requesting clarity around when to expect full guidance to be released, but has yet to receive a response.