Under 21 CFR 1306.51, effective December 31, 2025, a DEA-registered practitioner may prescribe buprenorphine for opioid use disorder after an audio-video or audio-only telemedicine encounter for up to six calendar months, after reviewing the PDMP of the patient's state. The pharmacist must verify the patient's identity. After six months, an in-person evaluation or another lawful pathway is needed.
Since December 31, 2025, a DEA-registered practitioner can prescribe buprenorphine for opioid use disorder after a telemedicine encounter, including an audio-only one, for up to six calendar months, without first seeing the patient in person. The authority is 21 CFR 1306.51, created by the DEA and HHS final rule Expansion of Buprenorphine Treatment via Telemedicine Encounter (90 FR 6504, January 17, 2025). Its effective date was delayed twice (90 FR 9841 and 90 FR 13410) before it took effect on December 31, 2025. It is a standing regulation under 21 U.S.C. 802(54)(G) and does not expire with the temporary telemedicine rule at the end of 2026.
What does 1306.51 cover?
Schedule III through V controlled substances listed in 42 CFR 8.12(h)(2) and approved by FDA for treating opioid use disorder. In practice, that means buprenorphine products. Methadone is Schedule II and is not covered. The prescription must follow a communication using an interactive telecommunications system as described in 42 CFR 410.78(a)(3), "including an audio-only telecommunications system."
Who can prescribe is unchanged by the rule. The Consolidated Appropriations Act, 2023 (Pub. L. 117-328) removed the DATA-waiver requirement, so, as the rule's preamble puts it, practitioners with authority to prescribe Schedule III controlled substances "can prescribe buprenorphine to their patients without needing a DATA waiver or having a limit or cap" on patient numbers. The practitioner still needs a DEA registration that covers Schedule III, or an exemption under 21 U.S.C. 822(d), and must meet DEA's one-time training requirement for new and renewing registrants; our sister White Glove CME covers that training.
What are the conditions?
- PDMP review first. The practitioner must be authorized to access the PDMP of the state where the patient is located at the time of the encounter, review the patient's controlled substance prescriptions for the past year (or the available period if shorter), and annotate the date and time of the review in the record before prescribing.
- If the PDMP is unavailable, document the attempt, its date and time and the reason the data could not be reviewed. The practitioner may then prescribe a seven-day supply, and must try the PDMP again before each further seven-day supply. Those seven-day supplies count toward the six months.
- Six calendar months. Prescriptions under 1306.51 may be issued "for a period not to exceed six calendar months beginning on the date the first prescription is issued." After that, further prescriptions need an in-person medical evaluation by the prescriber, or another pathway under 21 U.S.C. 829(e).
- Pharmacist ID check. The pharmacist must verify the patient's identity before filling, with a government-issued photo ID or other identification. A qualifying "ultimate user," such as a household member, may present it.
- OUD only. Prescriptions under this section may only be for treating opioid use disorder.
- Everything else in part 1306 still applies.
How does it interact with the temporary rule in 2026?
Through December 31, 2026, a practitioner can choose. DEA's fourth temporary extension (90 FR 61301) says the temporary rule and the two January 2025 final rules are "three separate and distinct sets of authorities," that a practitioner may prescribe under the temporary rule "even if he/she could also issue that prescription under one or both of the Two Final Rules," and that only a prescription issued under 1306.51 needs to meet 1306.51's requirements. DEA notes the temporary rule "imposes fewer requirements," but it ends in December, and a program built on it has to move to 1306.51 or another pathway by January 1, 2027.
The question to settle with counsel is when the six-month clock starts for a patient you began treating by telemedicine in 2026 under the temporary rule. The rule text counts from the first prescription issued under 1306.51. It does not say how earlier prescriptions under other authority are treated. Do not assume a patient started in July 2026 has a fresh six months on January 1, 2027 without advice.
What happens at month six?
The patient needs one of these:
- An in-person evaluation by the prescribing practitioner, with the patient in their physical presence. Once that happens, DEA's view is that the Ryan Haight Act restrictions no longer apply to the relationship.
- A telemedicine pathway under 802(54), such as the patient being seen at a DEA-registered clinic or with a registered practitioner present, or, if it is finalized, a special registration.
- A transfer to a local prescriber or opioid treatment program.
Build the month-six step into the treatment plan at intake. The practices that struggle with this rule are the ones that discover the deadline in month five.
What does a compliant tele-OUD workflow look like?
- Location at the start of every visit. The PDMP you must check is the one for the state where the patient is located during the encounter. Ask and record it each time; see verifying patient location.
- PDMP access in every state you serve, arranged before the first patient from that state books. Some states only grant access to prescribers licensed there. See PDMP checks for telehealth prescribers.
- A structured PDMP note with date, time, state and result, or the reason it could not be done.
- A six-month date field in the EHR, set at the first 1306.51 prescription, with a task at month four.
- Pharmacy coordination. Tell patients to bring ID to the pharmacy, and pick partner pharmacies that stock buprenorphine.
- State law checks. Some states have their own rules on office-based opioid treatment, counseling referrals or telehealth prescribing of controlled substances; check each in our state telehealth law index.
Our DEA Telemedicine Readiness engagement ($1,450) maps your OUD patients to the right authority and builds these workflows for your counsel to review. For the wider picture, see what changes on January 1, 2027 and the DEA telemedicine rules hub. Practitioners who need a DEA registration in another state can file through White Glove APRN (NPs), White Glove PA (PAs) or White Glove IMLC (physicians).
Common questions
- Can buprenorphine be prescribed over the phone?
- Yes. 21 CFR 1306.51 allows buprenorphine for opioid use disorder to be prescribed after an audio-only telemedicine encounter, for up to six calendar months from the first prescription under that section, after a PDMP review.
- Does the buprenorphine telemedicine rule expire at the end of 2026?
- No. It is a standing regulation that took effect December 31, 2025. The separate temporary rule for other controlled substances expires December 31, 2026.
- What if the PDMP is down?
- Document the attempt with the date, time and reason. The practitioner may prescribe a seven-day supply and must try the PDMP again before each further seven-day supply. Those supplies count toward the six-month limit.
- Do I still need an X-waiver to prescribe buprenorphine?
- No. The Consolidated Appropriations Act, 2023 removed the DATA-waiver requirement. A practitioner whose DEA registration covers Schedule III can prescribe buprenorphine without a waiver or a patient cap.
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