Telehealth for opioid treatment: US rules and what to ask elsewhere

In the US, clinicians can start buprenorphine over telehealth, including audio-only visits, under a permanent federal rule, while other countries set their own rules, so confirm with a local prescriber.

What the US rule says

The Drug Enforcement Administration and health officials made the buprenorphine telemedicine flexibilities permanent. A clinician can start buprenorphine and prescribe up to a six-month supply from the date of the first prescription after a telehealth visit. SAMHSA's questions-and-answers page sets this out. The MAT Act page adds that buprenorphine, a Schedule III medication, can be prescribed by telehealth where federal and state rules allow.

Audio-only counts in the US

The 42 CFR Part 8 final rule allows screening for buprenorphine initiation by audio-only or audio-visual telehealth. A phone call can be enough to start. Methadone is different: induction stays in person at a certified opioid treatment programme. Telehealth covers buprenorphine induction there too, not methadone.

What to ask any telehealth prescriber

Ask whether the first visit can be remote or must be in person. Ask how urine testing works at a distance. Ask how you receive the prescription and which pharmacy fills it. Ask what happens if you need an earlier review. Write the answers down with the prescriber's name.

Outside the US: what we can say

This directory covers six countries. We state only what our sources state, and our sourced telehealth position is the US one above. In the UK, Canada, Australia, Ireland and New Zealand, prescribing rules, controlled-drug schedules and funding differ, and they change. Use this site's telehealth filter as a starting point, then phone the service and ask: can assessment happen remotely, which parts need a visit, and who prescribes.

Watch for misleading adverts

Honest telehealth services name their prescribers, explain testing, and never promise a prescription before assessment. Avoid any service that guarantees medication, asks for payment by gift card or cryptocurrency, or has no verifiable address. Report suspect listings to hello@opioidtreatment.fyi.

This guide is information only. It is not medical advice.