Ryan Haight, COVID Waivers, and the DEA's 2023-2025 Telemedicine Rulemaking
The Controlled-Substance Telehealth Cliff and the Special-Registration Saga
Evidence grade 5 of 5, Settled. Read how the Atlas grades evidence.
The written rationale for this grade is still being prepared.
- FDA
- DEA-administered amendment to the Controlled Substances Act
Reference only. Not medical advice.
What can go wrong
A platform prescribing testosterone purely online without satisfying Ryan Haight (an in-person exam, a valid exception, or an active flexibility) faces DEA enforcement risk; patients face the prospect that their access could change abruptly if the flexibility lapses or a stricter final rule lands. An online TRT offer with no in-person evaluation and no acknowledgment of the regulatory uncertainty is a red flag.
This is something to take to a clinician. The Atlas can tell you what is known about ryan haight, covid waivers, and the dea's 2023-2025 telemedicine rulemaking in general. It cannot tell you what is happening in your body, and the difference matters most for exactly the symptoms that bring people to this page.
This entry tracks the rulemaking arc, not just the 2008 statute. The Ryan Haight Act required an in-person evaluation before prescribing a controlled substance online and directed DEA to create a 'special registration' for telemedicine, which DEA never built for over a decade. The COVID-19 public health emergency (declared 2020) triggered temporary flexibilities waiving the in-person rule. DEA's first proposed permanent rules in early 2023 drew record negative comment; the agency instead issued successive temporary extensions, with telemedicine prescribing flexibilities extended through the end of 2025 and into 2026 while a durable framework remains unfinished.
Online TRT runs on a temporary COVID waiver that DEA keeps extending, the permanent rule still is not settled.
What people take it for
What it is taken for. Approval, where it exists, covers only some of these.
How it works
Ryan Haight makes online dispensing of a controlled substance unlawful absent a valid prescription predicated on an in-person evaluation or a statutory telemedicine exception. The COVID flexibility temporarily let practitioners prescribe controlled substances via audio-video telemedicine without a prior in-person visit. Because testosterone is Schedule III, TRT telehealth depends on that flexibility. DEA's attempt to replace it with a permanent rule, variously proposing in-person referral requirements, a special-registration track, and prescription registries, stalled amid industry and patient pushback, so the agency has governed by serial extension.
Why the cliff matters specifically to TRT
ED telehealth scaled freely because sildenafil and tadalafil are not controlled and never touched Ryan Haight. Testosterone is Schedule III, so the entire at-home online TRT model rests on the COVID-era waiver. If DEA finalizes a rule requiring an in-person visit (or a qualifying referral) before controlled-substance telemedicine, the frictionless online-TRT promise could contract sharply. The repeatedly extended flexibilities (the most recent extensions carrying the rules toward 2026) are a temporary scaffold, not settled law, which is why the marketplace watches each DEA extension notice closely.
What people get wrong
Often saidThe in-person rule is permanently gone
ActuallyIt is suspended by temporary, repeatedly extended COVID-era flexibilities; no permanent rule has been finalized.
Often saidDEA built the telemedicine special registration long ago
ActuallyCongress mandated it in 2008, but DEA left it unimplemented for over a decade, which is central to the current uncertainty.
Often saidOnline TRT and online Viagra carry the same legal risk
ActuallyViagra is not controlled and is untouched by Ryan Haight; testosterone is Schedule III and depends entirely on the telemedicine flexibility.
Who profits, and who pushes back
Nobody is named here yet, because we have not done that work on this entry. Read that as unfinished. Somebody almost certainly sells this, and somebody almost certainly disputes it. Assume both until we have checked.
At a glance
- Statute
- Ryan Haight Act of 2008 (amends the Controlled Substances Act)
- Special registration
- Mandated by Congress in 2008; left unimplemented for years
- COVID flexibility
- Began March 2020 with the public health emergency
- 2023 NPRMs
- DEA's proposed permanent rules drew tens of thousands of mostly critical comments
- Extensions
- Temporary telemedicine flexibilities extended into the 2025-2026 window pending a final rule
What this entry does not yet cover
What follows is unfinished work on our side, not a finding about Ryan Haight, COVID Waivers, and the DEA's 2023-2025 Telemedicine Rulemaking. A short entry is not a safe entry.
- Cost and market. We have not documented what it sells for or who sells it.
- Supply chain. We have not mapped where it is made.
- Who uses it. We have not documented the user groups.
- What could change. No forward-looking summary yet.
- How it compares. We have not set it against the alternatives.
- Children and teenagers. We have not checked what is known about younger people.
Sources
The studies below are named and described, but not linked. You cannot open them from here and check our reading against them, which means this page is our summary of the literature rather than a document you can verify. Weigh it accordingly until the links exist.
The studies that matter
Ryan Haight Online Pharmacy Consumer Protection Act2008
Required in-person evaluation and directed DEA to create a telemedicine special registration
DEA/HHS COVID telemedicine flexibilities2020
Temporarily waived the in-person requirement for controlled-substance telemedicine
DEA proposed telemedicine rules2023
Drew record public comment; permanent framework deferred via extensions
Successive temporary extensions2023-2025
Carried flexibilities forward pending a final rule