In my November 2025 blog post, I discussed the uncertainty surrounding the DEA’s then-pending telemedicine rule and its implications for ketamine clinics. At that time, the future of pandemic-era telehealth prescribing flexibilities was unclear, and clinics across the country were bracing for the possibility of a significant regulatory shift at the end of 2025.

Now, the DEA has provided much-needed clarity: On December 31, 2025, the agency, in coordination with the Department of Health and Human Services, published its Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications. This extension ensures that the telemedicine prescribing practices ketamine clinics have relied on since the start of the pandemic will remain in place through December 31, 2026.

What Does the New Extension Mean?

Key takeaways for ketamine clinics:

• Telemedicine flexibilities for prescribing controlled substances—including ketamine—are now extended through December 31, 2026.

• DEA-registered practitioners may continue to prescribe Schedules II-V controlled substances via telemedicine (as defined in 21 CFR 1300.04(i)), without an in-person medical evaluation, provided all other federal and state requirements are met.

• The extension covers all practitioner-patient relationships established through telemedicine from May 12, 2023, onward.

This move is designed to prevent an abrupt end to remote prescribing for patients who have not had an in-person evaluation, referred to as the “telemedicine cliff,” while the DEA finalizes permanent regulations.

What Remains the Same?

As outlined in my previous post (published November 25, 2025), the core requirements for telemedicine prescribing remain unchanged under this extension:

• Prescriptions must be for a legitimate medical purpose and issued in the usual course of professional practice.
• The telemedicine encounter must use an interactive telecommunications system (typically audio-video; in some cases, audio-only for certain medications).
• The practitioner must be properly authorized and registered with the DEA.
• All other DEA, federal, and state requirements must be met.

What Should Ketamine Clinics Do Now?

Stay vigilant and compliant:

• Continue to monitor DEA and state regulatory updates. The current extension is temporary, and further changes are likely as the DEA works toward permanent telemedicine rules.
• Keep protocols current. Ensure your clinic’s telehealth policies, documentation, and staff training reflect the latest federal and state requirements.
• Prioritize patient safety. Maintain robust screening, consent, and follow-up procedures.

Looking Ahead

While this extension provides critical continuity for patients and clinics, it is not a permanent solution. The DEA has signaled its intention to develop a final regulatory framework for telemedicine prescribing of controlled substances. Ketamine clinics should use this time to prepare for potential changes, strengthen compliance efforts, and continue delivering safe, effective care.

Bottom line

The DEA’s fourth extension means ketamine clinics can continue telemedicine prescribing through at least the end of 2026. However, the regulatory environment remains in flux, and proactive compliance is essential.

For additional background, see my original analysis from November 2025 here.