In today’s digital health landscape, telemedicine prescribing of controlled substances — including ADHD stimulants, buprenorphine for opioid use disorder (OUD), benzodiazepines, and other Schedule II–V medications — has transformed access to mental health care. Yet concerns about medication diversion, illicit sale, and abuse remain valid.
At FasPsych, our telepsychiatry providers take these risks seriously. We implement stricter, more standardized safeguards than many traditional in-person practices, making telepsychiatry one of the safest and most accountable models for prescribing controlled substances via telemedicine.
Telemedicine Prescribing Controlled Substances: Why Telepsychiatry Providers Are Especially Vigilant About Diversion
Remote care eliminates some in-person cues, so we rely on objective tools, clear protocols, and transparent communication. All telepsychiatry prescribing is performed only when authorization granted by applicable federal and state law is in place. This vigilance — shaped by the Ryan Haight Act, DEA regulations, and state laws — often results in more consistent monitoring than seen in many brick-and-mortar clinics, and every practitioner acting in this setting must adhere strictly to these regulations. Under the telemedicine flexibilities, DEA-registered practitioners are permitted to remotely prescribe Schedule II-V controlled medications via audio-video telemedicine encounters without having ever conducted an in-person medical evaluation. All controlled substances are prescribed pursuant to these legal requirements.
Core Safeguards in FasPsych Telepsychiatry Prescribing Controlled Substances
Our protocols include:
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Short initial supplies and limited refills — Starting with 7–30 days, with early refills requiring documented justification, follow-up, and often testing.
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Routine laboratory monitoring — Urine drug testing (UDT) at intake and intervals to verify adherence and detect misuse if appropriate.
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Mandatory PDMP checks — Real-time review of state Prescription Drug Monitoring Programs (and interstate data) before every controlled substance prescription.
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Clear treatment contracts — Written agreements outlining secure storage, no sharing, no early refills, and consequences of non-adherence.
All protocols are designed to meet remote prescribing requirements established by federal and state authorities.
Each prescribing practitioner at FasPsych maintains current DEA registration to ensure regulatory compliance when prescribing controlled substances via telemedicine. The interactive telecommunications system used by FasPsych provides secure, HIPAA-compliant video and audio connections, supporting safe and compliant telemedicine encounters.
Telemedicine Prescribing Flexibilities and Guidelines
The landscape of telemedicine prescribing of controlled substances continues to evolve, with the Drug Enforcement Administration (DEA) and Health and Human Services (HHS) working together to ensure both access and safety. DEA-registered practitioners are permitted to remotely prescribe Schedule II-V controlled medications via audio-video telemedicine encounters without having ever conducted an in-person medical evaluation, provided that such prescriptions comply with DEA guidance documents and applicable federal and state law. Under the Fourth Temporary Extension, DEA-registered practitioners can continue prescribing controlled substances—including Schedule II-V controlled medications—via telemedicine encounters through December 31, 2026. The DEA has stated that the extension will allow sufficient time for providers to come into compliance with any new DEA registration, recordkeeping, or security requirements eventually adopted in a final set of regulations. This extension preserves critical telemedicine flexibilities that were first introduced during the public health emergency.
For most controlled substances, practitioners may prescribe after a thorough audio-video telemedicine encounter, even if an initial in-person medical evaluation has not yet occurred. Many stakeholders pointed out that the requirement for an in-person evaluation would make it more challenging for certain patients to continue receiving the controlled medications they need. This is especially important for patients with mobility limitations or those in rural and underserved areas, where access to in-person psychiatric care can be challenging.
Additionally, for Schedule III-V narcotic controlled medications approved by the Food and Drug Administration (FDA) for maintenance and withdrawal management treatment of opioid use disorder, the rules are even more flexible. These medications can be prescribed following an audio-only telemedicine encounter, again without requiring an in-person medical evaluation. This approach helps ensure continuity of care for individuals managing opioid use disorder, while still adhering to applicable federal and state law, DEA guidance documents, and DEA regulations.
The Fourth Temporary Rule, supported by the Mental Health Services Administration (SAMHSA), extends these telemedicine prescribing flexibilities and provides time for the DEA to conduct a thorough regulatory review and develop permanent regulations. The goal is to balance access to essential mental health and substance use disorder treatment with robust safeguards against diversion into the illicit drug market. As the regulatory environment continues to evolve, FasPsych remains committed to full compliance and to supporting our partners in navigating these changes.
The Power of Electronic Prescribing of Controlled Substances (EPCS)
EPCS is a cornerstone of safe telemedicine prescribing of controlled substances. Prescriptions transmit directly from our secure EHR to the pharmacy — eliminating paper scripts that can be lost, stolen, forged, or altered.
Benefits of EPCS include:
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Dramatic reduction in fraud and diversion (no physical prescription to tamper with)
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Real-time PDMP integration
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Full audit trail for accountability
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Compliance with growing state and federal mandates, including adherence to final rules issued by the DEA
At FasPsych, EPCS is standard for all medications. Combined with our other safeguards, it creates a closed-loop system that is exceptionally difficult to exploit. Learn more about our medication management services.
FasPsych closely monitors regulatory changes, including new DEA registration requirements and the implementation of final rules governing telemedicine prescribing. We are fully prepared to comply with any security requirements eventually adopted as part of these regulations, ensuring ongoing legal compliance and the highest standards of patient safety.
The Role of the Drug Enforcement Administration DEA
The Drug Enforcement Administration (DEA) plays a pivotal role in shaping the standards and requirements for prescribing controlled substances via telemedicine. As the primary federal agency responsible for enforcing the Controlled Substances Act, the DEA sets the framework that all telepsychiatry providers must follow to ensure the safe and legitimate medical use of controlled medications.
DEA regulations and guidance documents outline the specific requirements for DEA-registered practitioners, including the need for secure prescribing practices, thorough patient evaluations, and strict record-keeping. The DEA acknowledged the abrupt cessation of Medicare’s telemedicine flexibilities on September 30, 2025, which previewed the negative impact a ‘telemedicine cliff’ has on patients’ access to care. The agency’s Diversion Control Division is tasked with preventing the misuse and diversion of controlled substances, while also ensuring that patients with legitimate medical needs maintain access to necessary treatments.
Through ongoing regulatory review and the issuance of temporary rules—such as the Fourth Temporary Extension—the DEA works closely with other federal partners, including HHS and SAMHSA, to adapt to the changing landscape of telemedicine. The proposed rule sought to establish three special registrations, creating pathways for telehealth practitioners to prescribe certain controlled substances via telemedicine. This includes authorizing telemedicine prescribing flexibilities during public health emergencies and developing permanent regulations that will eventually replace pre-pandemic restrictions.
For telepsychiatry providers like FasPsych, compliance with DEA regulations is not just a legal requirement—it is a core part of our commitment to professional practice and public health. By staying current with DEA guidance and maintaining rigorous security requirements, we help ensure that the prescription of controlled medications via telemedicine remains both accessible and safe for the communities we serve.
Telepsychiatry Often Exceeds In-Person Safety Standards
Traditional practices may issue longer supplies based on rapport alone and perform fewer routine labs or PDMP checks. Telepsychiatry’s regulatory scrutiny and remote nature drive more standardized, documented, and objective processes — resulting in a safety net that frequently surpasses conventional care.
Currently, the rule extends telemedicine flexibilities and, compared to the two final rules under consideration, imposes fewer requirements on practitioners.
Research Shows Low Diversion Risk with Proper Safeguards
Data from the COVID-19 telehealth flexibilities period confirm that expanded remote prescribing did not drive meaningful increases in diversion or misuse. Regulatory changes and research findings related to telemedicine prescribing of controlled substances are documented in the Federal Register and in final rules titled to address telemedicine prescribing.
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Buprenorphine for OUD: Telehealth flexibilities increased treatment initiation and retention with no significant rise in diversion or overdose involving the medication. Federal reviews found benefits outweighed risks, and such prescriptions are permitted under current telemedicine flexibilities. Pandemic telehealth flexibilities for buprenorphine treatment: synthesis of evidence
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Stimulants for ADHD: A 2025 study in the American Journal of Psychiatry (7,944 patients) found telehealth initiation did not increase overall risk of subsequent substance use disorder (adjusted OR 1.15, not significant). Purely telehealth ongoing care showed no elevated risk. Under these rules, providers are authorized to prescribe Schedule II-V medications. Telehealth Prescribing of Stimulants for ADHD and Associated Risk
These findings align with broader evidence: when layered safeguards like those at FasPsych are in place, telemedicine prescribing of controlled substances is safe and expands access without compromising public health.
FasPsych: A Model of Responsible Telepsychiatry Care
We view safe prescribing as a core responsibility. By combining clinical expertise, technology (universal EPCS), objective monitoring (labs + PDMP), and strong patient partnerships, FasPsych delivers high-quality mental health treatment with some of the strongest protections against diversion available.
As telemedicine prescribing controlled substances continues to evolve, the risk of a telemedicine cliff—where temporary telemedicine flexibilities abruptly expire—remains a concern. Without further regulation and the establishment of permanent laws, patient access to care could be disrupted, especially for those relying on Medicare’s telemedicine flexibilities. Additionally, requirements for patient prior in-person evaluations are changing as regulations develop, making it essential to stay informed and compliant to ensure safe and effective prescribing practices.
Responsible telepsychiatry is not a shortcut — it is accountable, patient-centered care that reaches those who need it most.
Patients, families, and referring providers can trust that medications prescribed through FasPsych come with rigorous safeguards protecting both the individual and the community.
Ready to partner with a telepsychiatry provider that prioritizes safety? Contact FasPsych or explore our telepsychiatry services.
Frequently Asked Questions (FAQ)
Q: Can FasPsych prescribe controlled substances via telepsychiatry?
A: Yes — our licensed psychiatrists and psychiatric nurse practitioners prescribe controlled substances (including Schedule II stimulants) in full compliance with federal and state regulations after thorough evaluation. Depending on current regulations, an initial in person examination or initial in person visit may be required before prescribing controlled substances. FasPsych is authorized to dispense controlled substances via telepsychiatry when permitted, including for Schedule III-V medications used in treating Opioid Use Disorder (OUD), following all legal and procedural requirements. All telemedicine encounters are conducted using the interactive telecommunications system referred to in federal regulations.
Q: How does FasPsych prevent diversion of controlled medications?
A: Through short initial supplies, routine urine drug testing, mandatory PDMP reviews, clear treatment contracts, and universal EPCS — creating multiple layers of accountability.
Q: Is electronic prescribing (EPCS) required at FasPsych?
A: Yes. EPCS eliminates paper scripts, reduces forgery risk, integrates PDMP data, and is standard for all controlled substances.
Q: Does telehealth prescribing increase diversion or substance use disorder risk?
A: No. Large studies during COVID flexibilities and recent 2025 research show no meaningful increase in diversion or SUD risk when proper safeguards are used.
Q: What happens if a patient shows signs of misuse or requests early refills?
A: We require justification and testing; non-adherence to the treatment contract may lead to tapering, discontinuation, or referral.
Q: How does FasPsych telepsychiatry compare to in-person prescribing safety?
A: Our protocols are often more standardized and objective, providing equal or stronger protection due to regulatory requirements and remote monitoring tools.
Q: What is the status of proposed rules for telemedicine prescribing of controlled substances?
A: Federal agencies have issued proposed rules to clarify and potentially extend telemedicine flexibilities, including special registration pathways and conditions for prescribing controlled substances without an initial in person visit. FasPsych closely monitors these regulatory developments to ensure ongoing compliance and to keep our partners informed of any changes affecting telemedicine prescribing practices.