DEA Is Gearing Up to Reshape Telehealth Prescribing Rules
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| The eventual rule changes are expected to affect the prescribing of all controlled substances, including at-home ketamine services. |
| The Drug Enforcement Administration just extended Covid-era telemedicine flexibilities for prescribing controlled substances through December 31, 2026, buying the agency more time to finalize permanent rules that will shape the future of virtual care. For ketamine telehealth providers — many of which have built national, mail-order businesses — this move offers temporary relief, but long-term certainty remains in question. |
| The extension preserves a drug prescribing practice that was prohibited prior to lockdowns: allowing clinicians to prescribe certain controlled medications without first conducting an in-person visit. Without it, federal rules would have reverted to pre-Covid standards, effectively shutting down large segments of telehealth prescribing overnight. |
| The delay doesn’t mean that the DEA is trying to eliminate the telehealth law amended during Covid. Rather, it reflects the DEA’s effort to close loopholes and tighten control over telemedicine frameworks. |
| “Covid didn’t create, but it exposed, a shortcoming in our prescribing rules,” said Matt Brockmeier, a drug policy attorney at Antithesis Law who advises psychedelic and cannabis-adjacent companies. “They didn’t reflect modern medical practice.” |
| The pandemic proved that in some cases, an entirely remote clinician-patient relationship can be appropriate, particularly when supported by lab work or monitoring that does not require an in-person physician visit. “Some type of modern telehealth prescribing regime makes sense,” Brockmeier said, especially given cost and barriers to access. |
| Still, the DEA’s proposed solution — which includes a new registration system for telehealth prescribers of controlled substances — has raised concerns across the industry. More regulation, particularly this kind, doesn’t necessarily favor smaller ketamine companies. |
| At the same time, Brockmeier emphasized that ketamine occupies a distinct regulatory space. Unlike the classic psychedelics, it is a synthetic pharmaceutical with known safety and addiction risks. “Instead of outright prohibiting telehealth ketamine, this feels like an acknowledgment that this [telehealth prescribing system] is going to happen, and here’s a system for doing it. It is good policy to have an already established system in place when other psychedelics, like psilocybin, MDMA, 5-MeO-DMT, or ibogaine are inevitably approved at the federal level.” |
| The DEA has said the temporary rule will operate alongside newer, more restrictive telehealth regulations already finalized for certain drugs, including buprenorphine, a drug used for opioid use disorder. That dual-track approach has left providers uncertain about what standards will ultimately apply to ketamine. |
| If the temporary flexibilities lapse at the end of 2026 without a replacement rule, the consequences could be immediate. Patients who have only ever received ketamine through telehealth could suddenly lose access, while providers would be forced to rapidly restructure or shut down entirely. |
| For now, the extension offers an extended window of time for ketamine telehealth companies to continue business as usual, while the DEA writes its new rules for at-home pharmaceutical drug services. The real question for ketamine telehealth is not whether regulation is coming—but how disruptive it will be when it does. |
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