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[Sticky] Controlled Substances


Michael Gray MD JD
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NOtelemedicine providers generally do not prescribe controlled substances.

🔎 What is a controlled substance?

Controlled substances are medications with potential for abuse or dependence, such as:

  • Stimulants (e.g., Adderall, Ritalin)

  • Benzodiazepines (e.g., Xanax, Ativan)

  • Opioids (e.g., oxycodone, hydrocodone)

  • Some sleep medications (e.g., certain formulations of zolpidem)

  • Others depending on state and federal schedules

These are regulated more strictly than non-controlled prescriptions under the Ryan Haight Act.

 


❗ Why telemedicine cannot prescribe controlled substances

Telehealth cannot prescribe controlled drugs if:

  • The clinician is not licensed in your state

  • The platform doesn’t meet federal telemedicine controlled-substance requirements

  • The clinician cannot establish a valid doctor-patient relationship under state/federal rules

  • It’s a first evaluation in certain contexts without in-person visit (still restricted in some cases)

Also, even where allowed, many providers will choose not to prescribe certain controlled meds via telehealth for safety reasons.


💊 Examples of controlled meds:

  • most pain medicines beyond NSAIDs
  • ADHD stimulants (e.g., Adderall, methylphenidate, Vyvanse, Concerta etc)
  • Anxiety meds (e.g., benzodiazepines)
  • Certain sleep meds (e.g., some sedative hypnotics like ambien/zolpidem)
  • sudafed
  • flexeril
  • sudafed
  • gabapentin
  • tramadol
  • testosterone
  • fioricet
  • fiorinal
  • lyrica 
  • Any medicine on the federal DEA scheduled controlled substance list.  Please see a provider locally for these:  www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_alpha.pdf 

These require appropriate screening, risk assessment, and often use prescription–drug monitoring programs (PDMPs).


✔️ What telemedicine can freely prescribe

These are not controlled and easier to get via telehealth:

  • Antibiotics

  • Birth control

  • Antivirals

  • Antihistamines

  • Non-opioid pain relievers (ibuprofen, acetaminophen)

  • Many psychiatric meds (SSRIs, SNRIs)

  • Some sleep medications not on controlled list (e.g., trazodone)


🧠 Why controlled prescribing is cautious

Clinicians must balance access with safety:

  • Risk of misuse, diversion, addiction

  • Need for monitoring (blood pressure, heart rhythm, substance use history)

  • Legal/regulatory compliance

So even when allowed, many telemedicine providers have strict policies.


🧾 What to expect on a telehealth controlled-substance visit

You’ll typically need:

  1. A valid ID and secure video platform

  2. Complete medical & medication history

  3. Discussion of risks, benefits, alternatives

  4. Consent for monitoring and follow-up

Even if some doctors offer this service, some may require an in-person visit first before offering telemedicine prescription renewals.


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