Can Online Doctors Prescribe Controlled Substances?

Written by

Jessica Guht

Jessica is a medical writer with an unquenched thirst to discover something new. She believes that medical content should be accessible to everyone and strives to write content that every single person can understand. When Jessica isn’t writing, she can usually be found reading a book with a dog cuddled in her lap. Jessica has a Masters of Engineering degree in Biomedical Engineering.

Medically reviewed by

Amy Dougherty, FNP-BC, AGAC

Amy is a Board Certified Family Health Nurse Practitioner (FNP) with over 15 years of experience working in Hospital Medicine, Urgent Care and Primary Care practices. Amy graduated Thomas Jefferson University with high distinction earning a Bachelor of Science in Nursing in 2008, a Master of Science in Nursing in 2010 and a Post Master's Certificate in Adult Gerontology Acute Care (AGAC) in 2014. She was recognized by the Elite American Nurses Association in 2013 for her dedication, achievements and leadership in the field Nursing. She served as a clinical preceptor for a number of Nurse Practitioner students and enjoys teaching the bright minds of future NPs.

Legally, online doctors in the United States can prescribe controlled substances if certain requirements are met.

Some examples are that the doctor must use both audio and visual communication to interact with the patient in real-time, if the doctor is legally able to based on state law and the prescription is issued for a medical purpose that is considered to be legitimate.

While legally possible, online prescriptions for controlled substances are not very common and most online doctors will likely not prescribe these types of medications.

This is due to the complexities and risks involved in prescribing controlled substances online as well as the majority of telehealth services prohibiting prescriptions for controlled substances.

Key takeaways:

• Online doctors in the US can prescribe controlled substances if certain requirements are met.
• The complexities and risks involved make it uncommon for online doctors to prescribe controlled substances.
• Most telehealth services prohibit prescriptions for controlled substances.
• Online doctors can prescribe almost everything an in-person doctor would prescribe.

Continue reading to learn more about the specific legal requirements for online doctors to prescribe controlled substances and the reasons behind the restrictions.

Table of Contents

• Who Are Online Doctors? 
• Can Online Doctors Prescribe Controlled Substances?
• When Can an Online Doctor Prescribe Controlled Substances?
• Can You Get Controlled Substances From an Online Doctor?
• Overall, What Won’t Online Doctors Prescribe You?
• What Can Online Doctors Prescribe?
• Key Takeaways 

Who Are Online Doctors?

Online doctors refer to medical professionals as well as academics who operate in an online setting. The popularity of online doctors has been steadily increasing since the early 2000s. As internet speeds increased, solutions including online doctors became more practical and accessible for patients. Today, online doctors can deliver a wide range of services online. They can provide:

• Health care
• Advice 
• Prescriptions 
• Evaluations 
• And More 

Online doctors are fully trained and qualified. As such, they are able to provide a diagnosis as well as treatment for a wide range of medical conditions. 

Can Online Doctors Prescribe Controlled Substances?

Online doctors are legally able to prescribe controlled substances if the correct measures are taken. 

Under the Ryan Haight Act, an in-person evaluation of a patient is required before an online doctor is able to prescribe a controlled substance. As such, legally, an online doctor will only be able to prescribe a controlled substance if the patient has already been examined by a doctor in person. 

This could be completed by a doctor connected to the telehealth service being used or a separate medical professional. 

When Can an Online Doctor Prescribe Controlled Substances?

The requirements under the Ryan Haight Act were declared void by the US Drug Enforcement Administration (DEA). Under the guidelines set out by the DEA, online doctors are able to provide prescriptions for controlled substances to patients who have not been seen in person for the duration of the COVID0-19 pandemic. However, certain conditions are relevant. 

For instance, the online doctor must use both audio and visual communication to interact with the patient in real-time. This means that an online doctor can not prescribe a controlled substance after diagnosing a patient from a video or image that they send. Controlled substances can also not be prescribed after simply speaking to them on the phone. 

The prescription must also be issued for a medical purpose that is considered to be legitimate and needs to be relevant to the usual course that an online doctor would take. 

Furthermore, an online doctor can only prescribe a controlled substance if they are legally able to based on state law. This means that if a state requires an in-person evaluation then an online doctor will not be able to provide a prescription for a controlled substance to a patient in that location. 

It is also worth noting that the COVID-19 changes to prescription regulations by the DEA are set to expire after May 11th, 2023. However, the DEA has already proposed new telehealth prescription guidelines. This would ban prescriptions for schedule II controlled substances without an in-person evaluation while allowing 30-day supplies for buprenorphine as well as various other Schedule III-V drugs. 

Can You Get Controlled Substances From an Online Doctor?

While legally an online doctor is able to provide controlled substances to patients, it is unlikely that you will be able to access them using a service like this. The reason for this is that the majority of telehealth services prohibit prescriptions for substances like this. 

The legal requirements are complicated and also depend on local state laws. Due to this, most services will avoid them altogether and will recommend that you seek out an in-person evaluation for controlled substances. 

Controlled substances are considered more dangerous compared to other medications that you can receive from a doctor. There is a risk of overdosing as well as the development of addictive behavior if prescriptions like this are not managed correctly. 

Overall, What Won’t Online Doctors Prescribe You?

Overall, a doctor will not prescribe controlled substances to patients online. It’s worth noting that this is the case regardless of whether local laws allow for this. 

Online doctors are still medical professionals and would rather a patient be seen in person before a prescription like this is provided. Again, the reason for this is that these drugs are considered to be dangerous if they are not used and prescribed correctly. 

That said, an online doctor can provide repeat prescriptions for a wide range of medications that you may need to treat or manage medical conditions that you are currently experiencing. 

What Can Online Doctors Prescribe? 

Online doctors are able to prescribe virtually everything an in-person doctor would prescribe. The only exception is controlled substances and medications. Some examples of the medication a doctor will prescribe online include:

• Antibiotics 
• Birth control pills
• Diabetes medication
• Hypertension medication
• Antidepressants 
• And More 

A telehealth marketing service will usually have a full list of the prescriptions that they currently offer. You might also be able to search for specific prescriptions to check whether you will be able to access these from your online doctor. Remember, if you do need a controlled substance, it is always worth booking an in-person evaluation. 

Key Takeaways 

In conclusion, legally due to emergency exceptions put in place during the COVID-19 pandemic, it is possible for online doctors to prescribe controlled substances to their patients. Online doctors are medical professionals with the qualifications required to complete prescriptions like this. 

However, they must interact with a patient in real time using both video and audio tools. This must also be in conjunction with state law. There are many states that do not allow for online prescriptions of controlled substances. 

Due to this, most telehealth services will not allow their medical professionals to provide these types of prescriptions. However, they can provide prescriptions for a range of other medications a patient may need. 

Sources:

• 9 ways Covid-19 may forever upend the U.S. healthcare industry. Stat news. Available from: https://www.statnews.com/2020/05/19/9-ways-covid-19-forever-upend-health-care/ 
• Telehealth: A quarter-trillion-dollar post-COVID-19 reality? McKinsey & Company. Available from: https://www.mckinsey.com/industries/healthcare/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality 
• Understanding Telemedicine and the Ryan Haight Act. Psychology Today. Available from: https://www.psychologytoday.com/gb/blog/when-your-adult-child-breaks-your-heart/202301/understanding-telemedicine-and-the-ryan-haight 
• Use of Telemedicine While Providing Medication Assisted Treatment (MAT). U.S. Department of Justice, DEA, Diversion Control Division. Available from: https://www.hhs.gov/system/files/hhs-telemedicine-dea-final-508compliant.pdf 
• What is a Controlled Dangerous Substance? Princeton University, Office of Environmental Health and Safety. Available from: https://ehs.princeton.edu/laboratory-research/animal-research/what-is-CDS 
• What Is a Controlled Substance? Very Well Mind. Available from: https://www.verywellmind.com/what-are-controlled-drugs-22310 
• Rasool MF, Rehman AU, Imran I, Abbas S, Shah S, Abbas G, Khan I, Shakeel S, Ahmad Hassali MA, Hayat K. Risk Factors Associated With Medication Errors Among Patients Suffering From Chronic Disorders. Front Public Health. 2020 Nov 19;8:531038. doi: https://www.doi.org/10.3389/fpubh.2020.531038.