Online Therapy
Understanding the DEA’s Proposed 50/50 Telehealth Rule
How new telehealth rule could create unnecessary barriers to mental health care.
Updated February 5, 2025 Reviewed by Davia Sills
Key points
- In general, telehealth has removed logistical obstacles so that patients can get the care they need.
- A new rule proposed by the DEA with in-person visit requirements could represent a step backward.
The DEA’s proposed 50/50 telehealth rule, which would limit telehealth prescribing of controlled substances to no more than 50% of a provider’s total controlled substance prescriptions, and require patients to attend in-person visits for the remainder, is a step backward in the evolution of psychiatric care. Of all medical specialties, psychiatry is the one that best lends itself to a virtual care model, and forcing patients into unnecessary in-person appointments will create barriers rather than benefits.
Telehealth has revolutionized psychiatric care by removing logistical obstacles that often prevent patients from seeking or continuing treatment. In our clinic, the impact has been overwhelmingly positive. Patients no longer need to arrange childcare, navigate unreliable transportation, or risk exposure to illness just to keep their appointments. Inclement weather and work schedules are no longer insurmountable barriers to care. As a result, compliance has improved, leading to better patient outcomes.
The requirement for half in-person visits does little to improve safety or care quality. It merely forces patients to jump through bureaucratic hoops that disproportionately affect those who are already vulnerable, such as those in rural areas, those with disabilities, and those struggling with severe mental health conditions. Mandating an in-person visit simply to “check a box” does nothing to address the real concerns surrounding controlled substances.
Instead of implementing arbitrary in-person requirements, we should focus on improving the standard of care through evidence-based practices. This includes:
1. Strengthening Identity Verification — Ensuring that both patients and providers are legitimate through secure telehealth platforms that use identity verification measures.
2. Educating Providers on Drug-Seeking Behaviors — Training clinicians to recognize red flags for substance misuse both in-person and virtually so they can make informed prescribing decisions.
3. Enhancing Safeguards for Controlled Substance Prescriptions — Implementing robust prescription monitoring programs, requiring providers to check databases for potential abuse patterns, and encouraging collaborative care models.
4. Evolving the Diagnostic Process to Include Validated Screening Tools — Ensuring clinicians utilize a comprehensive assessment process to aid in diagnostic decision-making, thereby moving away from a model of diagnosing and treating based solely on patient self-report.
Telehealth has made mental health care more accessible, reliable, and effective. The DEA should prioritize policies that enhance patient safety and provider accountability without creating unnecessary barriers to care. The goal should be to refine and improve virtual care standards, not impose outdated restrictions that disregard the realities of modern psychiatric treatment.
Let’s focus on what truly matters—delivering high-quality, accessible, and safe care to those who need it most.
References
DEA announces three new telemedicine rules that continue to open access to telehealth treatment while protecting patients. DEA. (n.d.). https://www.dea.gov/press-releases/2025/01/16/dea-announces-three-new-t…