If you prescribe controlled substances over telehealth, think ketamine, TRT, certain weight and wellness protocols, you got a reprieve. The DEA extended the telehealth flexibilities again, through the end of 2026. And the most dangerous way to read that is “great, nothing to do.”

What happened

The DEA and HHS issued a fourth temporary extension of the COVID-era telemedicine flexibilities. From January 1 through December 31, 2026, DEA-registered practitioners can keep prescribing controlled substances via telehealth to patients they haven’t seen in person, including Schedule II to V through audio-video visits.

The part everyone’s going to miss

Two words: fourth and temporary. This is the fourth time the DEA has kicked the can, and the agencies are now framing it as the bridge to a permanent rule, not another open-ended patch. So don’t bank on a fifth. To understand why that matters, you have to know what the flexibilities are actually pausing.

The legal read: the Ryan Haight Act, and the fix that’s 17 years late

The underlying law is the Ryan Haight Online Pharmacy Consumer Protection Act of 2008. Its baseline rule: a practitioner generally must conduct at least one in-person medical evaluation before prescribing a controlled substance by telemedicine, with only narrow exceptions. The COVID public health emergency waived that in-person requirement, and every “telehealth flexibility extension” since, including this one, is simply a continued waiver of Ryan Haight’s in-person rule.

Here’s the part that tells you where this is going. Ryan Haight also directed the DEA, back in 2008, to build a special registration pathway, a way for qualified practitioners to prescribe controlled substances by telemedicine without the in-person visit. DEA never built it, until a proposed rule in January 2025 floated three special registrations. That rule still isn’t final. So the permanent fix Congress asked for 17 years ago is the very thing DEA keeps buying time to finish.

Which means there’s a cliff. When the waiver finally ends without a final Special Registration in place, the Ryan Haight in-person requirement snaps back to full force. The runway isn’t for coasting. It’s for getting ready for that.

Now make it about you

If your model depends on remote controlled-substance prescribing, you have less than half a year of certainty and an unknown amount after that. Use the months to build the muscle a Special Registration regime, or a Ryan Haight snap-back, will demand, instead of discovering you don’t have it the week the rule drops.

What to do with this

• Treat the flexibilities as a temporary waiver of Ryan Haight, not the new normal. Don’t build a model that only works if they’re permanent.
• Tighten your documentation now: the patient evaluation, the medical necessity, the records that show a real clinical relationship behind every controlled-substance script.
• Watch the Special Registration rulemaking and assume it will require registration and recordkeeping you should already be doing.
• Build an in-person or hybrid touchpoint into high-risk prescribing where you can, so a future in-person requirement doesn’t break your model overnight.

The headline is more telehealth flexibility. The lesson is that “temporary, extended a fourth time, and pointed at a permanent rule” is the DEA telling you to get ready for the in-person rule to come back, not to relax.

Real compliance strategy from a real attorney.

Y’all stay protected out there.

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Want your telehealth prescribing workflow built to survive whatever the Special Registration rule, or a Ryan Haight snap-back, turns out to require? That’s exactly what we do inside The Protected Practice.

Court Approved Council is owned by Court Approved, PLLC and is not a law firm. Nothing here is legal advice and no attorney-client relationship is formed.