DEA Extends Telehealth Rules for Controlled Substances Through 2026
The Drug Enforcement Administration just gave ketamine telehealth providers another year. On December 30, the agency extended COVID era flexibilities that allow practitioners to prescribe controlled substances via video visits. The new deadline: December 31, 2026.
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| Key Takeaways | |
|---|---|
| New Expiration Date | December 31, 2026 |
| What It Covers | Schedule II through V controlled substances, including ketamine |
| In Person Requirement | Still waived for telehealth prescribing |
| Why It Matters | Prevents abrupt disruption to telehealth ketamine services |
| What Comes Next | Permanent regulations expected before extension expires |
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Why the Timing Matters
The agencies published this rule on the second to last day of the year. They had no choice. The previous extension expired on December 31, 2025. Without action, practitioners would have faced immediate restrictions under the Ryan Haight Act. That law requires at least one in person evaluation before prescribing controlled substances remotely.
The DEA calls this scenario the “telemedicine cliff.” The term captures the abrupt return to pre pandemic rules. For telehealth ketamine companies, such a cliff would have forced major operational changes overnight.
The Numbers Tell the Story
Consider what the agencies found during their review. Of 44.6 million controlled substance prescriptions written in 2024, about 7 million came without a prior in person visit. That represents 16 percent of all such prescriptions.
The DEA also pointed to a recent warning sign. When Medicare telehealth flexibilities briefly lapsed in September 2025, visits dropped 24 percent within 17 days. Some states saw declines of 40 percent or more. Florida, Louisiana, and New York all experienced sharp reductions.
What This Means for Ketamine Providers
Telehealth ketamine companies can continue operating under familiar rules. Nothing changes on January 1. Practitioners can still prescribe ketamine via video consultation without first meeting patients in person.
But this extension carries an important caveat. The DEA has spent years working toward permanent regulations. In 2023, the agency proposed two rules that drew over 38,000 public comments. In January 2025, it unveiled a Special Registration framework. That proposal generated another 6,475 comments.
Preparing for What Comes Next
The word “temporary” appears throughout this rule for good reason. Permanent regulations will arrive before December 2026. The DEA has signaled that new requirements around registration, recordkeeping, and security are coming.
Smart operators will use this year wisely. The time to audit compliance practices is now. Building relationships with patients through occasional in person touchpoints may prove valuable. Providers who wait until the next deadline approaches may find themselves scrambling again.
The full rule took effect January 1, 2026.
