Drug Enforcement Administration
8701 Morrissette Drive
Springfield, VA 22152

Re: Public Comment on DEA’s Proposed Telehealth Prescribing Rules for Controlled Substances

To Whom It May Concern,

We are writing to express our concerns regarding the DEA’s proposed rule changes for telemedicine prescribing of controlled substances, particularly the restrictions on prescribing stimulant medications via telehealth. As a licensed attorney representing healthcare providers and a psychiatric nurse practitioner providing direct patient care, we are deeply invested in policies that balance patient access to essential medications with responsible prescribing oversight.

Furthermore, we are joined by the undersigned nurse practitioners who support our assertions. The undersigned include actively practicing nurse practitioners and aspiring nurse practitioners who have a vested interest in advocating for equitable and safe access to patient care.

While we appreciate the DEA’s efforts to create structured pathways for telemedicine prescribing, the current proposal unnecessarily restricts access to care for patients who rely on stimulant medications for conditions such as ADHD. ADHD is often misunderstood, yet studies show that a lack of appropriate medication management doesn’t just result in difficulty focusing at work or school. When left untreated or poorly managed, ADHD significantly increases the risk of motor vehicle accidents, substance abuse, and even earlier mortality. The proposed restrictions could lead to detrimental consequences for patients who depend on stimulant medications for their overall health and well-being.

We urge the DEA to reconsider the following aspects of the proposed rules:

1.     Eliminating the State-Based Restriction for Stimulant Prescribing – The requirement that providers must be physically located in the same state as the patient disproportionately harms individuals in rural areas, underserved communities, and those who rely on telehealth due to mobility, financial, or geographic constraints. These restrictions will limit patient access to qualified providers, exacerbating existing healthcare shortages.

2.     Allowing Qualified Telehealth Providers to Prescribe Stimulants – The proposed “Advanced Telemedicine Prescribing Registration” unnecessarily limits stimulant prescribing to select subspecialists, such as psychiatrists and neurologists. However, board-certified psychiatric nurse practitioners (PMHNPs) and primary care providers are often the ones managing ADHD treatment, particularly in rural and underserved areas. Restricting their ability to prescribe stimulants via telehealth will lead to delays in care and potential patient harm.

3.     Reducing the Administrative Burden on Providers – The additional reporting and recordkeeping obligations create further strain on healthcare providers already struggling with excessive administrative tasks. One particularly problematic requirement is the limitation that stimulant prescriptions must remain under 50% of a provider’s total controlled substances prescriptions. This threshold will force providers to constantly monitor and regulate the proportion of stimulant prescriptions they issue within a specific timeframe. More importantly, because a provider cannot predict exactly what a patient will need over the course of their care, this restriction may result in providers having to turn away both new and existing patients who need treatment for certain conditions if the 50% threshold has already been met at that time. This creates an artificial barrier to care and places providers in an ethical dilemma, forcing them to choose between compliance and providing necessary treatment.

The DEA’s proposed rule changes make progress by providing more structured telehealth pathways, but they simultaneously take a step backward by disproportionately impacting patients with legitimate needs for stimulant medications. Instead of improving access, these restrictions will likely push vulnerable patients toward unregulated or unsafe alternatives.

We urge the DEA to consider revisions that allow for continued responsible telehealth prescribing of stimulant medications without unnecessary in-person requirements, state-based limitations, or excessive administrative burdens. Doing so will help ensure that patients receive timely, evidence-based care without placing undue strain on the already burdened healthcare system.

We appreciate the opportunity to provide input and look forward to continued collaboration to find a balanced approach that protects public health while maintaining access to essential treatments.

Sincerely,

Nicholas R. Webb, RN, DNP, ESQ
Partner, Balestra Webb Law

Alysha Woods, PMHNP, MSN
CEO, Rooted Psychiatry