Controlled substances are used to treat many common mental health conditions, like anxiety, depression, sleep disorders, and more. Prior to the COVID-19 pandemic and national health emergency, federal rules regulated how these meds were prescribed and dispensed - including a requirement for an in-person health evaluation prior to a prescription being written. However, during the pandemic, federal regulators temporarily waived these regulations to permit patients the ability to manage their medication and access to prescriptions, including controlled substances via telehealth visits.
With the national health emergency waivers expected to expire soon, some states have stepped in to draft their own medication management legislation; the result has been growing confusion over which rules apply and where. In this article, we attempt to answer all your questions about prescribing controlled substances, and have included resources to find out more.
Why are Some Medications Deemed Controlled Substances?
Controlled substances by definition are medications with a likelihood for physical or mental dependence. Many of the more common drugs for ADHD, anxiety, sleep disorders, depression, and more, such as Xanax, Klonopin, Lunesta, and Adderall are listed as ‘controlled substances”. The U.S. Controlled Substances Act (1970) puts all substances which were in some manner regulated under existing federal law into one of five schedules. This placement is based on the substance’s medical use, its potential for abuse, and safety or dependence liability. Medications listed as Schedule I have the tightest controls, and those listed as Schedule V have the least restrictive controls. These controls are mandated by the federal government.
This may all sound complicated - but it boils down to prescribers and pharmacies taking extra precaution to ensure these medications are prescribed for and delivered to the right individuals, for the right reasons.
What Are the Extra Steps Clinicians Must Take to Prescribe Meds that are Deemed Controlled Substances?
In general, to prescribe a controlled substance, a clinician must have a DEA (Drug Enforcement Administration) license, and to fill a prescription, a pharmacist must also have a controlled substance license. Further, for a pharmacist to dispense a controlled substance, the prescription must include specific information such as date of issue, patient’s name, address, and DoB, clinician name, address and DEA number, drug strength, number of refills, and the signature of the prescriber. For these kinds of medications, there are also legal limits on the number of refills and the amount that a prescription may contain. Some drugs have zero refills, and the maximum quantity dispensed is 30 days - meaning patients must contact their clinician each month a refill is needed.
In addition, the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 specified that “any practitioner issuing a prescription for a controlled substance must conduct an in-person medical evaluation. A conservative recommendation to support compliance with the act is to conduct an in-person exam at least once every 24 months.”
How did the COVID-19 Pandemic Impact Prescriptions of Controlled Substances?
The unprecedented public health emergency created by COVID-19 caused action by state and federal regulators to ensure greater access to health care, while simultaneously limiting the spread of the virus. Therefore, as of March 2020, the DEA declared that practitioners “may issue prescriptions for controlled substances to patients via telemedicine, even for patients for whom they have not conducted an in-person medical evaluation, provided the prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of their professional practice, the telemedicine communication is conducted using an audiovisual, real-time, two-way interactive communication system, and the practitioner is acting in accordance with applicable federal and state laws.” At that time, the DEA also ruled it was “permissible to write controlled substance prescriptions to cover a 90-day supply.”
However, depending on where you live or who prescribes your meds, you may have had a different experience as certain states and practitioners elected to retain pre-COVID protocols of in-person evaluations given the sensitivity of the medication being administered.
What is the Current Status of Controlled Substances Prescriptions?
As we move through 2022 and the threat of COVID-19 has lessened, requirements for prescribing and dispensing controlled substances in some states have begun making permanent changes to expand policies implemented under the public health emergency, while others have passed laws restricting them. This website has made an attempt to track these ongoing changes - but to be safe, always check with your own state’s official website, or contact your state or federal representatives.
The DEA at the federal level said in a March press release, that it “wants medication-assisted treatment to be readily and safely available to anyone in the country who needs it." However, in the end it is up to each state and provider to do what they feel is best for the safety of constituents and/or patients. Therefore, check with your provider or prescriber to find out if you will need an in-person visit to continue receiving prescriptions of controlled substances or if telehealth visits are an option for you. Telemynd operates as a national practice, meaning that our national network of licensed providers may prescribe many types of medications, they follow federal regulation which prevents the prescribing of controlled-substances via our virtual telemedicine environment.
DEA.gov: Rules for Control Substances
NIH | National Library of Medicine: Pharmacy Prescription Requirements