QA Telemedicine - DEA Registration in other states

Drug Enforcement Administration
Diversion Control Division
Guidance Document
Title: Telemedicine
Question: I am registered with DEA in one state, but will be prescribing controlled substances
to patients in another state via telemedicine in a manner permitted by the Ryan Haight Act. Will I
need to hold a separate DEA registration in the state where my patients are located?
Answer: Yes (with certain limited exceptions, including an exception broadly applicable during
the COVID-19 public health emergency). The Controlled Substances Act (CSA) generally
requires practitioners prescribing controlled substances to patients in another state via
telemedicine to be registered in those patients’ state. The CSA does so in two distinct but
partially overlapping ways.
First, unless subject to an exception, the CSA requires all practitioners to be registered in the
state in which the patients to which they are prescribing controlled substances are located,
regardless of whether the prescribing is taking place via telemedicine. The CSA provides that
every person who dispenses, or who proposes to dispense, any controlled substance shall obtain
from DEA a registration issued in accordance with DEA rules and regulations. See 21 U.S.C.
822(a)(2). Under the CSA, such dispensing includes prescribing and administering controlled
substances. Id. 802(10). DEA may only register a person to dispense a controlled substance if
that person is permitted to do so by the jurisdiction in which his or her patients are located. See
id. 802(21), 823(f). Thus, unless an applicable exception applies, DEA regulations require a
practitioner to obtain a separate DEA registration in each state in which a patient to whom he or
she prescribes a controlled substance is located when the prescription is made, regardless of
whether the prescription is made via telemedicine.
Second, in addition to this generally applicable registration requirement, the CSA also contains
provisions (added by the Ryan Haight Act) expressly requiring a practitioner to be registered in
the state in which the patient to whom he is prescribing is located when he or she is engaged in
certain forms of telemedicine. Under the CSA, a prescription for a controlled substance issued by
means of the Internet must generally be predicated on an in-person medical evaluation. See id.
829(e)(1). This requirement does not apply, however, when a practitioner is practicing
telemedicine as defined by the CSA. The CSA’s definition of the practice of telemedicine
includes multiple different categories of telemedicine. And, for certain of these categories, the
CSA specifically requires a practitioner of telemedicine to have a DEA registration in the state in
which the patient is located. See, e.g., id. 802(54)(A)(ii)(III), (E), 831(h)(1)(B).
There are, however, certain limited exceptions to both the general and telemedicine-specific
registration requirements. Most notably, DEA is permitted to waive practitioners’ general
registration requirements by regulation when consistent with the public health and safety, id.
822(d), and has done so for certain categories of practitioners. See 21 CFR 1301.23. The CSA
also waives the telemedicine-specific requirement of registration in the patients’ state for

telemedicine practitioners in these categories. See 21 U.S.C. 802(54)(A)(ii)(III)(a),
831(h)(1)(B)(i). Thus, practitioners in these registration-waived categories can prescribe
controlled substances to patients in another state via telemedicine without being registered in that
state.
Exceptions may also apply in certain other situations. In particular, during the COVID-19 public
health emergency, DEA has granted a temporary exception to its regulations—Exception to
Separate Registration Requirements Across State Lines (DEA067), issued March 25, 2020—to
allow practitioners to prescribe controlled substances in states in which they are not registered if
the practitioner is registered with DEA in at least one state and has permission under state law to
practice using controlled substances in the state where the dispensing occurs. In other words,
under this exception, a DEA-registered practitioner is not required to obtain additional
registration(s) with DEA in the additional state(s) where the practitioner’s dispensing (including
prescribing and administering) occurs if the practitioner is authorized to dispense controlled
substances by both the state in which the practitioner is registered with DEA and the state in
which the dispensing occurs. Practitioners may utilize this temporary exception via in-person
prescribing or prescribing via telemedicine. Id. 802(54)(D). A practitioner using this exception
must continue to comply with the laws and regulations of the state in which they are DEA-
registered, and the laws and regulations of the state in which they are practicing, if different.
DEA has granted this exception through the duration of the COVID-19 public health emergency
as declared by the Secretary of Health and Human Services.
The CSA also authorizes the practice of telemedicine by a practitioner registered in any state
during certain limited medical emergency situations requiring immediate intervention to avoid
imminent and serious clinical consequences, such as further injury or death. Id. 802(54)(F).
Thus, practitioners generally must be registered with DEA in a patient’s state to prescribe
controlled substances to that patient via telemedicine, but a number of exceptions to that
requirement exist.
Guidance documents, like this document, are not binding and lack the force and effect of law,
unless expressly authorized by statute or expressly incorporated into a contract, grant, or
cooperative agreement. Consistent with Executive Order 13891 and the Office of Management
and Budget implementing memoranda, the Department will not cite, use, or rely on any guidance
document that is not accessible through the Department’s guidance portal, or similar guidance
portals for other Executive Branch departments and agencies, except to establish historical facts.
To the extent any guidance document sets out voluntary standards (e.g., recommended practices),
compliance with those standards is voluntary, and noncompliance will not result in enforcement
action. Guidance documents may be rescinded or modified in the Department’s complete
discretion, consistent with applicable laws.
EO-DEA192, DEA-DC-044, July 28, 2020