Telehealth for addiction medicine, extended again: what the DEA’s fourth one-year extension means in 2026

On December 31, 2025, the DEA and HHS jointly extended the COVID-era telemedicine flexibilities that allow practitioners to prescribe Schedule II–V controlled medications without a prior in-person evaluation. The extension covers calendar year 2026 — the fourth time the agencies have punted on the long-promised Special Registration for Telemedicine.

For people in recovery, the practical effect is that virtual access to buprenorphine, methadone (in narrow contexts), and other addiction medications continues without disruption. The SAMHSA statement accompanying the extension notes that a separate final rule made buprenorphine telehealth initiation permanent for the first six months of treatment with a new patient. After that window, an in-person visit becomes part of the requirement.

What stays available through 2026

DEA-registered practitioners can prescribe Schedule II–V controlled medications via audio-video telemedicine to patients they have never seen in person. Schedule III–V medications used for opioid use disorder maintenance or withdrawal management — buprenorphine being the obvious one — can be prescribed via audio-only telemedicine. The fourth extension also covers practitioners who started seeing patients during the original COVID flexibilities; their existing prescribing relationships do not need to be re-established.

What is still not settled

The extension is still temporary. The Special Registration for Telemedicine — which would create a permanent framework for remote controlled-substance prescribing — has been promised for years and is now in its sixth year of debate, as Fierce Healthcare noted. Patients and providers are operating under what is effectively a permanent-because-it-keeps-getting-extended rule, which is a fragile foundation for clinical relationships that often last years.

For the digital-first virtual MAT providers — Bicycle Health, Boulder Care, Workit Health, Ophelia — the extension is a continued tailwind. For the people they serve, it is the difference between continuity and disruption.

Why this matters for people in recovery

The simplest version of the story is that you can still see a buprenorphine prescriber over video, today, for the first time, and start treatment that day. That has been true since 2020. It will continue to be true through 2026. If you live somewhere where the nearest in-person OUD clinic is hours away — which is most of rural Arizona — that is the difference between treatment and no treatment.

If you want help finding a virtual MAT provider that takes your insurance, that is exactly what Rize is built to do. Start at rizerecovery.org. It takes a few minutes and is free.

If you or someone you know is in immediate danger, call 911 or 988.