📅 2026 Update: Changes in Telehealth and Substance Use Treatment

Since the original article was published, there have been important updates in telehealth and substance use treatment regulations. These changes affect how patients access controlled substances and mental health services. The earlier article continues after this update.

🩺 📞 Telemedicine Flexibilities

The U.S. Department of Health and Human Services (HHS) and the Drug Enforcement Administration (DEA) have extended telemedicine flexibilities for prescribing controlled substances through December 31, 2026. This rule allows DEA-registered practitioners to prescribe medications classified as Schedule II-V via telehealth.

Patients no longer need a prior in-person visit, making it easier to access necessary medications from home.

💊 📅 Buprenorphine Telemedicine

On January 17, 2025, a final rule made the telemedicine prescribing of buprenorphine permanent. This medication is essential for treating opioid use disorder. Patients can now continue to access this treatment through telehealth providers without needing to visit a clinic in person.

🧠 ⚖️ Mental Health Parity Rules

On September 9, 2024, new rules were released to strengthen the Mental Health Parity and Addiction Equity Act (MHPAEA). These rules ensure that mental health and substance use disorder benefits are treated equally to medical and surgical benefits. This change became effective on November 22, 2024, and will apply to individual health insurance coverage starting January 1, 2026.

🔒 📜 Confidentiality Regulations

In February 2024, changes were made to the Confidentiality of Substance Use Disorder Patient Records. These updates align aspects of the regulations with the Health Insurance Portability and Accountability Act (HIPAA). This helps ensure better protection of patient records and promotes confidentiality in treatment settings.

📌 Key Points Summary

  • 📅 Telemedicine flexibilities for controlled substances are extended to December 31, 2026.
  • 💊 Buprenorphine telemedicine prescribing is now permanent.
  • ⚖️ New rules strengthen mental health parity in insurance coverage.
  • 🔒 Updated confidentiality regulations enhance patient privacy protections.
  • 📞 Patients can access treatments via telehealth without in-person visits.

💡 Tips for Understanding Telehealth and Substance Use Treatment

It's important to review your specific situation with an attorney.

💻 🩺 Use Telehealth for Convenience

Telehealth services allow patients to consult with DEA-registered practitioners from home. This can save time and make it easier to get prescriptions for controlled substances.

📅 📞 Schedule Promptly

Some telehealth platforms offer same-day consultations, while others may take longer to schedule. Check with your provider to understand their processing times to get timely access to necessary medications.

🧑‍⚕️ 📜 Complete Required Forms

If seeking buprenorphine treatment via telemedicine, be prepared to fill out intake forms. These forms help the provider assess your eligibility for the treatment.

📞 💬 Check Provider Policies

Before scheduling an appointment, confirm whether the provider prescribes controlled substances. Some telehealth platforms, like Teladoc Health, do not prescribe these medications due to regulatory constraints.

🆓 📞 Seek Free Resources

If you need help with mental health or substance use issues, consider contacting the Substance Abuse and Mental Health Services Administration (SAMHSA). They offer a national helpline at 1-800-662-HELP (4357) for information and treatment referrals.

🏆 Services Ranked by User Reviews (2026)

This section lists services relevant to telehealth and substance use treatment, reflecting user reviews and experiences. The ratings are based on Trustpilot data checked in October 2026. Always remember that star ratings can change, and unhappy customers may leave more feedback, which can affect the overall scores.

🥇 1. Hims & Hers Health

Hims & Hers Health has been rated 3.0. This service is known for online healthcare services and prescription medications. However, it has faced customer service issues and concerns about product effectiveness.

🥈 2. LifeStance Health

LifeStance Health holds a Trustpilot score of 4.0. It offers mental health services, including therapy and telehealth options. Reviewers have noted inconsistent service quality and challenges with appointment availability.

🥉 3. Talkiatry

Talkiatry has received a score of 2.4. This service is recognized for online psychiatry and medication management. However, users have mentioned limited insurance coverage and variable quality among clinicians.

4️⃣ Direct Meds

Direct Meds has an impressive score of 4.6. It specializes in GLP-1 telehealth services and offers compounded medications like semaglutide and tirzepatide. Some users have pointed out limited insurance acceptance and potential medication side effects.

🆓 Free Government and Nonprofit Help

The U.S. Department of Labor provides resources and assistance regarding the Mental Health Parity and Addiction Equity Act (MHPAEA). Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a national helpline for individuals seeking treatment referrals.

🔎 What to Compare When Choosing a Service

  • 💬 Customer service responsiveness
  • 🩺 Provider qualifications and specialties
  • 📝 Availability of telehealth options
  • 🔍 Insurance acceptance and costs
  • 📅 Scheduling flexibility and appointment wait times

❓ Frequently Asked Questions

🤔 What are the eligibility requirements for telehealth prescriptions?

To qualify for telehealth prescriptions for controlled substances, patients must have a video consultation with a DEA-registered practitioner. The practitioner will evaluate the patient's medical history and current condition.

📅 How long do telehealth consultations take?

Processing times vary by provider. Some platforms may offer same-day appointments, while others might take several days.

💊 Is buprenorphine available through telemedicine?

Yes, buprenorphine is available through telemedicine. Patients must find a provider who offers this service and complete necessary intake forms.

🧠 What are the new rules regarding mental health services?

The new rules under the Mental Health Parity and Addiction Equity Act ensure equal coverage for mental health and substance use disorder benefits compared to medical benefits. These rules are effective starting January 1, 2025, for group health coverage.

🔒 How are patient records protected under new regulations?

Recent changes align some confidentiality regulations with HIPAA, enhancing protections for substance use disorder patient records. This helps maintain patient privacy during treatment.

📞 Where can I find free assistance for substance use issues?

Individuals can contact the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP (4357) for free information and treatment referrals.

⚖️ Recent Cases Related to Substance Use Treatment

Recent court rulings have focused on the implications of telehealth regulations and access to controlled substances. These cases are important for understanding how laws are evolving in response to the changing landscape of healthcare.

For more information, you can browse more rulings on the news page.

End of October 2026 Update






 



What is Promethazine?



 

Promethazine


 



Promethazine is a type of antihistamine. Belonging to the phenothiazine family, Promethazine yields anti-motion sickness, anticholinergic and antiemetic effects. Moreover, Promethazine is used as a sedative and in some countries, is prescribed to combat insomnia. Promethazine is available over the counter in Australia, Switzerland and the United Kingdom; it is only procured via prescription in the United States. Common brand names of Promethazine are: Fargan, Granesse, Avomine, Romergan, Promethagan, Phenergan, Prothiazine, Atosil, and Sominex in the United Kingdom. 



Promethazine is effective because it alters the actions of chemicals in the brain. Promethazine also acts as an antihistamine; the drug blocks the naturally-occurring effects of histamine in the body. As a result of these effects, Promethazine is used to combat allergy symptoms, such as runny nose, itching, watery or itchy eyes, hives, itchy skin rashes and sneezing. Moreover, Promethazine also prevents motion sickness and combats nausea and vomiting or soreness following surgical procedures. Promethazine should not be administered to treat symptoms associated with pneumonia, asthma or any other lower respiratory tract infection. 



 



 



Side Effects Associated with Promethazine:



 



 



Common side effects of Promethazine include:



 



 



•Confusion (mostly observed in elderly patients)



 



 



•Chest Pressure/Discomfort (typically observed when patient is already taking medication to treat high blood pressure)



 



 



•Parasethisia (tingling, burning, prickling or numbing sensations)



 



 



•Euphoria (this side effect of Promethazine is extremely rare; it is often observed with high doses or in co-administration with CNS depressants/opioids 



 



 



•Constipation



 



 



•Respiratory depression (often observed in patients under the age of 2 and for those patients with severely compromised pulmonary functions)



 



 



•Fatigue, vertigo (rare), drowsiness and dizziness



 



 



•Dry mouth



 



 



•Irritability/Short Temper



 



 



•Extreme side effects of Promethazine include: Neuroleptic malignant syndrome and seizures 



 



 



Because of Promethazine’s potential for more severe side effects, the drug is placed on the list to avoid for elderly patients. In several countries, Promethazine is contra-indicated in patients who are under the age of 2 years old. Promethazine is not recommended for children between the ages of 2 and 6 because of its propensity to cause sleep apnea and respiratory depression. 



 



 



You must immediately stop using Promethazine—and contact your doctor—if you experience twitching or uncontrollable movement of your tongue, face, lips, arms, legs or eyes. These symptoms could be early signs of severe side effects. Promethazine should never be administered to children under the age of 2 years old. Patients taking Promethazine must avoid drinking alcohol; the combination of Promethazine and alcohol can increase some of the above side effects. If you are taking any other medication with Promethazine you must tell your doctor. This includes minerals, vitamins, herbal products and any drug prescribed by another doctor. 



 



 



Before taking Promethazine, you must inform your doctor regarding the presence of any of the following medical conditions:



 



 



•History of seizures



 



 



•Glaucoma 



 



 



•Adrenal Gland Tumor



 



 



•Enlarged prostate or difficult urinating



 



 



•Low levels of calcium in your blood



 



 



•Bone marrow depression



 



 



•Sleep Apnea



 



 



•Severe asthma, chronic obstructive pulmonary disease or other types of breathing problems



 



 



•Kidney or liver disease



 



 



•Stomach ulcers or digestive obstructions



 



 



If you have a history of any of the above conditions you must inform your doctor to undertake a dose adjustment of Promethazine.



 



 



The effects of Promethazine on unborn babies are currently unknown. Regardless, you must inform your doctor if you are pregnant or plan to become pregnant during the administration of Promethazine. 



 



 



How do I take Promethazine?



 



 



You must take Promethazine exactly how it is prescribed by your doctor. Never waver from your doctor’s prescription; do not take Promethazine in larger amounts or for extended periods of time. You must follow the directions on the prescription. Promethazine may be taken with or without food. You should store Promethazine at room temperature and away from heat, light and moisture. 



 



 



What to Avoid when taking Promethazine?



 



 



Promethazine may cause severe side effects that can ultimately impair your reactions or thinking. Please be careful when driving or doing anything that requires you to be alert. Avoid getting up too quickly from sitting or lying positions. Also, avoid drinking alcohol and extended exposure to sunlight or tanning beds when on Promethazine. You should tell your doctor if you are using any of the following drugs/medicines when on Promethazine:



 



 



•Lithium



 



 



•Any type of blood pressure medication such as guanethidine, propranolol, guanethidine etc.



 



 



•Blood thinners



 



 



•Urinary or bladder medications, such as oxybutynin, solifenacin, etc. 



 



 



•Any medicine used to combat Parkinson’s diseases, including pituitary gland tumors, restless leg syndrome etc. 



 



 



•Any medicine administered to treat irritable bowel syndrome or stomach ulcers



 



 



These are just a few examples of medicines that can counteract or negatively affect the administration of Promethazine. To be safe, you should tell your doctor about all of your over-the-counter and prescription medications, minerals, herbal products, vitamins and any other drugs prescribed by other doctors. It is strongly advised that you do not start new medications without informing your doctor. 



 



 



Legal Issues Associated with Promethazine:



 



 



In 2009, the United States Supreme Court ruled on a product liability case involving Promethazine. The case revolved around Diana Levine, a woman suffering from migraine headaches, who was administered Promethazine via an IV. Promethazine was injected improperly resulting in gangrene. Because of the faulty administration—and the subsequent gangrene—Levine’s right forearm was amputated. A state jury awarded Mrs. Levine $6 million in punitive damages. 



 



 



Levine’s case was appealed to the United Supreme Court on the grounds of substantive due process and federal preemption. The United States Supreme Court upheld the original ruling rendered by the state court, stating that the drug’s manufacturer (Wyeth Corporation) could have added a stronger warning concerning the IV administration without violating federal law. In essence, the United States Supreme Court ruling means that the drug manufacturers can be held liable for injuries or the development of medical conditions if warnings regarding potential adverse effects are deemed inefficient by the lower courts. 



 



 



On September 9th of 2009, the United States Food and Drug Administration rendered a decision that a black box warning for injection of Promethazine must be placed on the drug’s packaging. The warning must state the contraindication for subcutaneous application or administration. Additionally, the warning must state that the preferred method of administration for Promethazine is intramuscular; this form of administration reduces the risk of tissue and surrounding muscle damage.