Dr. Ashley Klein, VMD
As veterinarians, DEA registration, compliance, and professional liability aren’t typically anyone’s favorite topics. In fact, the very mention of these topics tends to bring on immediate feelings of stress and anxiety, leading to avoidance by most. Unfortunately, whether we talk about it or not, as a veterinary professional, questions surrounding controlled substance compliance and liability are something we have to deal with.
This led Roo to organize an incredibly educational webinar with Simple Solutions 4 Vets presented by Dr. Peter Weinstein and Kelley Detweiler entitled: “The 4 P’s of Relief Veterinary DEA Compliance.”
You can now watch this webinar at any time on Roo’s Vet Concierge:
This presentation offered information on existing regulations in addition to recommendations and best practices designed to help relief veterinarians meet and/or exceed Federal DEA licensing requirements.
In this article, we’ll review the information provided in that presentation, address questions head on, and help break the cycle of worry and anxiety that normally comes with talk of the DEA. Who knows, maybe this article will be so engaging that it’ll inspire your holiday family conversation! Either way, our hope is that these recommendations help inform and guide your decisions so that you can feel more confident when working with controlled substances as a relief veterinarian.
Your frustration and confusion is valid!
If DEA regulation and controlled substance requirements at both the state and federal levels have left you frustrated and scratching your head, you’re not crazy. And, most importantly, YOU’RE NOT ALONE! Below are some explanations for why it can feel so confusing/frustrating:
- The rules were written with a focus on human healthcare, not veterinarians, resulting in a lot of confusion for the veterinary industry.
- A DEA registration is connected to one principal place of business. Relief veterinarians often work in more than one location and, in many cases, more than one state simultaneously.
- Most veterinary facilities operate under an individual’s DEA practitioner registration rather than a hospital or institution registration because many states don’t allow veterinary facilities to apply for institutional status at the state level. This means you won’t be able to prescribe or dispense controlled substances without your own individual DEA registration.
- The DEA has provided a few provisions and clarifications to existing regulations, which have failed to focus on a locum tenens capacity and have therefore not helped relief veterinarians.
- For example: The Veterinary Mobility Act of 2014 (Mobility Act) only focused on veterinary DEA registrants crossing state lines with their own controlled substance inventory to treat their own patients. Therefore, the Mobility Act does not cover standard relief veterinarians who travel to facilities to use that facility’s controlled substances to treat their patients.
- Each state is different, and state law supersedes federal law, so you have to know and adhere to state requirements in addition to DEA requirements.
- For example, some states require approval from the facility you work at prior to using controlled substances EVEN if you have a DEA license. Know your state requirements.
You can find state DEA information and prescription regulations by calling your state Veterinary Medical Association (VMA), the State Board of Pharmacy, or by contacting Simple Solutions 4 Vets.
Applying for a DEA Registration
Every veterinarian who orders, dispenses, prescribes, administers, or wastes a controlled substance needs to be registered with the DEA unless exempt. If you don’t have a DEA registration, you can only administer in-house controlled substances when working as a relief veterinarian under another person’s individual DEA registration.
If, based on this, you feel you need a DEA registration, below are some step-by-step guidelines for getting a DEA registration:
1. Controlled Substance License
If your state requires a separate controlled substance license, you must get this BEFORE you apply for a federal DEA registration.
2. Choose a principal location
Determine the principal location where you want to use your DEA registration. Below are some options (keep in mind, you must also research and follow state guidelines, not included here):
Home Address
You may use your home address as a principal location for your DEA registration. If you do, here are a few things to consider:
- You’ll be able to prescribe controlled substances and administer in-house controlled substances at other locations in the same state, but you CANNOT directly dispense them without registering those individual locations.
- This only works if you’re working in the state you live in. For example, if your home is in Pennsylvania, you cannot use it to apply for a DEA registration in New Jersey, a state that requires a “brick and mortar” location.
- This technically opens your home to a DEA search, so it’s best to designate a specific area within your home as the principal location on the DEA registration. By designating one area, you ensure that the DEA only has the authority to search that area and not your entire home.
- If you currently use your home address, you can amend your registration to list a specific location.
- The specific location should be included in the section titled “Address Line 2.” Some examples:
- The upstairs hall closet
- Garage
- Master bedroom closet
- You should ensure you have proper documentation in that specific location of your home (see step #3 below for details).
- If you have a personal inventory of medications, then you need to have them in secure storage. This means they have to be in a safe, and if the safe is less than 750 lbs, it needs to be attached to an immovable object (wall, fridge, or floor).
- Even if you have no drugs stored in your home, it can still be nice to have a locked space for your documentation to prevent it from getting lost or other people moving it.
Trusted Relief Facility
Alternatively, you can use the address of a trusted relief facility as a principal location. Here are a few things to consider:
- You must ask permission from the facility to use their address as you are opening them up to a DEA search.
- With a DEA registration under one facility as the principal location:
- You can administer, dispense, or prescribe controlled substances at that location.
- You can prescribe controlled substances and administer in-house controlled substances at other locations in the same state. But you CANNOT directly dispense them without registering those individual locations.
- It is important to keep proper documentation at that location (see step #3 below).
Other factors to consider
Some other key factors about choosing a principal location:
- If you travel between states often for relief work, you should have a DEA registration for each state you work in and pay taxes to.
- The principal location listed on your DEA registration must be a physical premises that can be inspected.
- You can always choose to only work as a relief veterinarian for facilities or institutions with their own registration.
- This would allow you to administer, dispense, or prescribe controlled substances under the registration of that hospital or institution without needing an individual DEA registration. However, you would need a specific internal code as an authorized practitioner.
- The downside to this is that very few facilities (mostly academic settings) have a hospital or institution registration.
3. Documentation and Inventory
Proper documentation includes:
- DEA registration
- Your state license
- Initial Inventory reflecting “zero”
- Biennial inventory reflecting “zero” (recommended)
Here’s a helpful DEA Inventory Form Template you can use.
4. How many DEA Registrations do you need?
Overall DEA compliance reminders and tips
No matter what path you choose for DEA compliance, it’s important to know about the facilities that you work at and ensure that they’re documenting the use of controlled substances appropriately.
Some things to consider and discuss when entering into a relief-provider relationship with a facility are:
- Keep a personal record of controlled substance use for your cases.
- Veterinary facilities are required to log all controlled substance use, but as a safeguard, it’s a good idea to keep your own records as a backup.
- Be aware of state-scheduled drugs. Many states have specific regulations around particular controlled substances such as Xylazine, Gabapentin, and even Propofol.
- Know the facility protocols and ensure that controlled substances are being logged appropriately.
- Always ensure there’s a witness when you’re involved with controlled substances.
- If you work as a relief veterinarian at a facility, you must be added to the authorized user list. It can also be helpful to know who the other authorized users are at the facility.
- Don’t advertise your DEA registration, but make sure to always keep a copy of your DEA registration, all relevant state licenses, any applicable proof of liability insurance, and your W-9 on-hand for verification.
- Keep your actual DEA registration document locked and safe at your principal location listed on your DEA registration.
- When refilling controlled substances for current clients of the primary veterinarian at a facility:
- It’s critical to know your state’s rules.
- Ensure there’s documentation of a veterinarian-client-patient relationship (VCPR), and verify if there is documentation of a plan for the controlled substance refill being requested. If you don’t have this, contact the primary veterinarian with the VCPR, and when in doubt, leave the refill to be completed by the primary veterinarian.
Prescriptions
A prescription must list your full name, principal location address from your DEA registration, and your DEA registration number.
- Can I prescribe using my own prescription pad?
- Depends on the state regulations. State regulations on prescriptions vary wildly — know your state’s rules, especially when it comes to Prescription Monitoring Programs (PMP).
- Can I prescribe using another veterinarian’s prescription pad?
- No. This is illegal.
Some final takeaway points
- Working relief through a group like Roo helps keep you better protected!
- The AVMA is working to clarify and improve these rules to better support veterinarians, especially relief veterinarians.
- The minimum DEA fine is $15,691 — proper handling of controlled substances is no joke!
For more information, feel free to check out the recording of our DEA webinar on Vet Concierge using the link below or reach out to Simple Solutions 4 Vets with specific questions.
