Is Telepsychiatry Good or Bad?

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 was enacted to close a specific legal loophole that allowed "rogue" online pharmacies to dispense controlled substances without a physical medical exam. While the broader opioid epidemic involved complex issues with manufacturers like Purdue Pharma and in-person medical practices, the Ryan Haight Act targeted a new, unregulated frontier: the internet.

Why Ryan Haight Was "Special"

Ryan Haight was an 18-year-old high school honors student from California who died in 2001 from an overdose of Vicodin.

• The Circumstance: He purchased the drugs from a "rogue" online pharmacy after a simple online consultation with a doctor he never met in person.

• The Legislative Impact: His death became a rallying point for families and lawmakers because it exposed how easily children and addicts could bypass traditional medical safeguards using the internet.

• The Core Requirement: The Act mandated that at least one in-person medical evaluation occur before a practitioner could prescribe controlled substances via the internet.

Extensions and Current Status (2026)

While the law has been on the books since 2008, the requirement for an in-person exam was temporarily suspended during the COVID-19 pandemic to ensure continued access to care.

• Current Extension: As of January 2026, the DEA and HHS have extended these "telemedicine flexibilities" through December 31, 2026.

• Reason for Extensions: The extension aims to avoid a "telemedicine cliff"—a sudden loss of access to medication for millions of patients (including those with mental health or substance use disorders) who started treatment via telehealth and haven't yet seen their provider in person.

• Permanent Rulemaking: Regulators are currently using this extra time to finalize permanent rules that balance patient access with safeguards against drug diversion.

Ongoing Challenges

Despite the Act, issues with "wrongly prescribing" stimulants and opioids persist because:

• In-Person Exemption: The Ryan Haight Act only regulates online prescribing. It does not change the laws governing traditional, in-person medical practices where many over-prescribing issues began.

• Telehealth Growth: The rapid expansion of telemedicine platforms has created new challenges for the DEA in monitoring prescribing patterns for medications like stimulants (used for ADHD) and opioids.

• Regulatory Complexity: Federal laws must compete with varying state laws, and the DEA is still reviewing thousands of public comments to find a balance between preventing abuse and ensuring legitimate patients can get help.