2008–2019

Federal regulation of teleprescribing began with the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which generally required an in-person medical evaluation before prescribing controlled substances through the Internet, unless a statutory telemedicine exception applied. Importantly, the Act applies to controlled substances, not ordinary non-controlled psychotropic medications such as most antidepressants, antipsychotics, and non-controlled mood stabilizers. In 2018, Congress passed the SUPPORT for Patients and Communities Act, directing DEA to create a special-registration pathway that would allow qualified clinicians to prescribe controlled substances through telemedicine without the traditional in-person examination. This established the statutory foundation for a permanent teleprescribing system, although DEA did not implement it before the COVID-19 pandemic (Ryan Haight Online Pharmacy Consumer Protection Act, 2008; SUPPORT for Patients and Communities Act, 2018).

2020–2024

Beginning in March 2020, DEA and HHS temporarily waived the Ryan Haight in-person requirement, allowing qualifying DEA-registered practitioners to prescribe Schedule II–V controlled medications through telemedicine without first examining the patient in person. These flexibilities were repeatedly extended to prevent disruptions in access to care. Louisiana followed the broader national movement toward telehealth accessibility with Act 322 of 2023, effective January 1, 2024, which directed licensing boards to “provide for, promote, and regulate” telehealth and generally prohibited requiring an in-person history or physical examination before a telehealth encounter, subject to controlled-substance exceptions. Louisiana further reduced barriers for Medical Psychologists through Act 731 of 2024, which broadened the required primary-care relationship from a physician specifically to a primary care provider, including physicians, physician assistants, and nurse practitioners (DEA & HHS, 2024; Louisiana Legislature, 2023, 2024).

2025–2026

In January 2025, DEA proposed a permanent Special Registrations for Telemedicine framework that would permit qualifying practitioners to prescribe certain controlled substances to patients they had never examined in person, subject to additional registration, monitoring, and recordkeeping requirements. DEA and HHS also finalized narrower permanent telemedicine pathways involving buprenorphine treatment and certain Veterans Affairs patients. As of September 19, 2026, the broader temporary telemedicine flexibility remains effective through December 31, 2026, while DEA's general permanent Special Registration rule has reached the Final Rule stage and is undergoing White House regulatory review. For clinicians practicing from abroad, no comparable Ryan Haight or DEA restriction currently prohibits prescribing non-controlled psychotropic medications solely because the U.S.-licensed prescriber is physically outside the United States. However, DEA's proposed permanent framework for controlled substances would require participating prescribers to be physically located within the United States during the telemedicine encounter (DEA, 2025; OIRA, 2026).

The overall policy trajectory has moved from an in-person-centered model, to broad emergency telehealth access, and now toward a permanent regulatory structure that recognizes telemedicine as an established method of prescribing and delivering psychiatric care. For non-controlled psychotropic medications, federal controlled-substance law does not impose an in-person examination requirement or an explicit requirement that the prescriber physically reside in the United States. State licensure, professional scope of practice, standard-of-care requirements, and any laws applicable in the country from which the clinician practices remain independently relevant. For controlled substances, the permanent federal framework is still being finalized and may ultimately impose additional geographic and registration requirements.

References

Drug Enforcement Administration. (2025). Special registrations for telemedicine and limited state telemedicine registrations. 90 Fed. Reg. 6541–6598.

Drug Enforcement Administration, & Department of Health and Human Services. (2024). Third temporary extension of COVID-19 telemedicine flexibilities for prescription of controlled medications. U.S. Department of Justice.

Drug Enforcement Administration, & Department of Health and Human Services. (2025). Fourth temporary extension of COVID-19 telemedicine flexibilities for prescription of controlled medications. 90 Fed. Reg. 61301–61306.

Louisiana Legislature. (2023). Act No. 322: Telehealth. La. R.S. §§ 40:1223.2–1223.5.

Louisiana Legislature. (2024). Act No. 731 (House Bill 828): Medical psychologists. La. R.S. §§ 37:1360.52–1360.62.

Office of Information and Regulatory Affairs. (2026). Special registrations for telemedicine and limited state telemedicine registrations (RIN 1117-AB40). Office of Management and Budget.

Ryan Haight Online Pharmacy Consumer Protection Act of 2008, Pub. L. No. 110-425, 122 Stat. 4820.

SUPPORT for Patients and Communities Act, Pub. L. No. 115-271, § 3232, 132 Stat. 3894 (2018).