Can a psychiatrist prescribe medication over the phone

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The internet has revolutionized countless aspects of modern life, and that includes mental health services. If you’ve wondered, can online therapists prescribe medication? The answer is yes, in some cases. 

Just as not all therapists can prescribe medications in-office, not all can prescribe drugs online. A therapist is an umbrella term for someone who has a license to practice therapy, but not all therapists have the same background. Only some healthcare providers (like licensed physicians and nurse practitioners) can prescribe drugs, whether in-person or online (NAMI, 2020). 

Here’s what you need to know about consulting with a telehealth provider and getting a prescription online. 

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Telehealth, a form of direct-to-consumer healthcare, is growing by leaps and bounds. 

The coronavirus pandemic has also supercharged the online migration of many health services including psychiatric care, which is sometimes called telepsychiatry (HHS-b, 2021). It refers to medical services (like mental health care) that are conducted over the phone or online, as opposed to in-person (HHS-b, 2022). 

In many cases, your provider offers all of their normal services over the internet. This includes psychotherapy (talk therapy), behavioral therapy, and if you see a psychiatrist online, prescriptions and renewals. 

Here are some of the benefits of telehealth and online therapy services (HHS-b, 2022):

• Receiving healthcare from the comfort of your own home
• Improved access for people who can’t make in-person visits
• The ability to work with specialists who live far away 
• Reduced wait times for appointments
• Increased privacy
• Health insurance still covers care

While there are many benefits, telehealth isn’t right for every individual.  

Yes, psychiatrists and other licensed therapists can prescribe medications online (NAMI, 2020). These include antidepressants and drugs commonly taken for mental health conditions like anxiety and bipolar disorder (Cornell, n.d.).

However, different states have different rules about telehealth prescriptions. It’s possible that your home state may have restrictions that prevent you from getting or refilling a prescription online. 

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Right now, only an authorized telehealth provider can write you a prescription or refill as long as they’ve performed a consultation that’s in real-time––meaning it involves two-way audio and video chat between you and a medical expert. 

Basically, this means you must have a live video meeting with your healthcare provider before they can write or renew a prescription. You can’t simply message them to ask for a new prescription or refill (DEA-b, 2020). 

Before COVID-19 swept the globe, U.S. psychiatrists providing services online were not allowed to write or refill certain prescriptions. Specifically, drugs classified as controlled substances (more on those below) couldn’t be prescribed without an in-person visit (Haque, 2021). 

Since then, regulations have changed. Authorized healthcare providers who are registered with the U.S. Drug Enforcement Agency (DEA) are allowed to issue prescriptions for some controlled substances without an in-person visit (HHS-a, 2022; HHS-a, 2021). 

Controlled substances prescribed to treat psychological conditions or mental illnesses include (Preuss, 2021):

• Anxiety drugs like lorazepam (brand name Ativan), alprazolam (brand name Xanax), and diazepam (brand name Valium)
• Ketamine
• Attention deficit hyperactivity disorder (ADHD) drugs, such as methylphenidate (brand name Ritalin) and Adderall 

Even though licensed psychiatrists can issue telehealth prescriptions for controlled substances, it’s important to note that these are drugs come with a high risk of addiction or abuse (DEA-a, 2020). 

Of course, your online provider can also write or refill prescriptions for most drugs that are not controlled substances. Examples of these include (HHS, 2020):

• Selective serotonin reuptake inhibitors (SSRIs), which are often used to treat depression, anxiety, and other mental health conditions
• Wellbutrin (generic name bupropion; see Important Safety Information), a common antidepressant 
• Mood stabilizers like lithium used to treat bipolar disorder

The importance of telehealth for mental health care

You can arrange a telehealth appointment with a provider you’ve met with in person before, or you may meet online with someone completely new.

In any case, the process is straightforward. During an initial consultation, they’ll ask questions about your medical history and symptoms over an online video platform. 

If they determine you need prescription medication, they may issue it directly to you or send it to your pharmacy. In the future, you can get prescription refills after an online follow-up consultation. If you have an online psychiatrist, they can also write referrals to other medical specialists (DEA-b, 2020).

Even before the pandemic, mental health treatment was moving online at a rapid pace. Going forward, online psychiatry is sure to have a big place in the U.S. healthcare system. 

1. Cornell Law School Legal Information Institute (Cornell). (n.d.). 21 U.S. Code § 829 – Prescriptions. Cornell Law School. Retrieved online March 10, 2022 from https://www.law.cornell.edu/uscode/text/21/829.
2. Haque, S. N. (2021). Telehealth Beyond COVID-19. Psychiatric Services (Washington, D.C.), 72(1), 100–103. doi:10.1176/appi.ps.202000368. Retrieved from https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.202000368
3. National Alliance on Mental Health (NAMI). (2020). Types of Mental Health Professionals. Retrieved from https://www.nami.org/About-Mental-Illness/Treatments/Types-of-Mental-Health-Professionals. 
4. Preuss, C. V., Kalava, A., & King, K. C. (2021). Prescription of Controlled Substances: Benefits and Risks. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537318/
5. U.S. Centers for Disease Control and Prevention (CDC). (2015). Prescription Drug Time and Dosage Limit Laws. Retrieved from https://www.cdc.gov/phlp/docs/menu_prescriptionlimits.pdf
6. U.S. Department of Health and Human Services (HHS-a). (2021). Prescribing controlled substances via telehealth. Retrieved from https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/prescribing-controlled-substances-via-telehealth/
7. U.S. Department of Health and Human Services (HHS-a). (2022). Renewal of De​​termination That A Public Health Em​ergency Exists. Retrieved from https://aspr.hhs.gov/legal/PHE/Pages/COVID19-14Jan2022.aspx
8. U.S. Department of Health and Human Services (HHS-b). (2021). Synchronous direct-to-consumer telehealth. Department of Health and Human Services. Retrieved from https://telehealth.hhs.gov/providers/direct-to-consumer/synchronous-direct-to-consumer-telehealth/
9. U.S. Department of Health and Human Services (HHS). (2020). Telemedicine and telehealth. Retrieved from https://www.healthit.gov/topic/health-it-health-care-settings/telemedicine-and-telehealth
10. U.S. Department of Health and Human Services (HHS-b). (2022). What is telehealth? Retrieved from https://telehealth.hhs.gov/patients/understanding-telehealth/
11. U.S. Drug Enforcement Administration (DEA-a). (2020). DEA Information on Telemedicine. Retrieved from https://www.samhsa.gov/sites/default/files/programs_campaigns/medication_assisted/dea-information-telemedicine.pdf
12. U.S. Drug Enforcement Administration (DEA-b). (2020). How to Prescribe Controlled Substances to Patients During the COVID-19 Public Health Emergency. Retrieved from https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-023)(DEA075)Decision_Tree_(Final)_33120_2007.pdf