Lacking a license to practice veterinary medicine also means lacking the authority to prescribe, administer and dispense controlled substances. This past September, the U.S. Drug Enforcement Administration rejected a Washington veterinarian’s application for a DEA registration (and any future application) because the state’s Veterinary Board of Governors had suspended her license in 2020. In another recent case, the agency revoked a veterinarian’s DEA registration after the Texas Board of Veterinary Medical Examiners temporarily suspended his veterinary license in early 2023. He defaulted six months later on a DEA-issued order to show cause. Those are just two examples of how not complying with state-level regulations can affect veterinarians at the federal level.
State licenses and DEA registrations are distinct but interconnected. While a state license is a fundamental credential authorizing you to practice veterinary medicine, a DEA registration is a federal credential allowing qualified, licensed entities or individuals to prescribe, administer and dispense controlled substances. Before you apply for or renew a DEA registration, make sure all required state licenses are valid.
State Regulations
While adhering to DEA drug-handling requirements is nonnegotiable, practitioners are also subject to state-specific laws. Depending on where you practice, local ordinances may apply as well.
With respect to state-level regulations, consider this:
- In Connecticut, prescribing practitioners cannot delegate any part of the dispensing process to non-DVMs.
- California requires Schedule II controlled substances to be inventoried at least every three months, in addition to DEA biennial inventories.
- Alabama, North Dakota and Georgia classify propofol as a Schedule IV controlled substance at the state level.
- An individual state’s rules regarding the veterinarian-client-patient relationship determine if and to what extent pet owners may obtain online prescriptions.
Unlike federal regulations, state laws can vary greatly and may apply to numerous aspects of veterinary practice and controlled substance use. Each state is different, from licensing and continuing education requirements to how controlled substances are prescribed, dispensed, supervised and reported. States may choose to follow federal guidelines in some areas and enact additional regulations in others.
Prescribing and Dispensing
Prescribing and dispensing are arguably where state regulations vary most significantly. For example:
- Emergency dispensing: States set their own rules for emergency prescriptions, such as the time limit for a prescriber to provide a written prescription after an oral order.
- Refills: Aside from federal requirements, state laws might dictate additional refill limits for controlled substances, though Schedule II drugs are never refillable.
- Dispensing: States vary on who may directly dispense controlled substances to patients, as well as how in-house dispensing may be conducted.
- PMP/PDMP: State prescription drug monitoring programs vary significantly with respect to registration, use and reporting requirements.
While federal laws set baseline prescribing and dispensing requirements, state boards of pharmacy primarily oversee these activities. From prescription pad requirements to prescribing and dispensing conditions, pharmacy boards control and monitor the activities through a system of reviews, quality-assurance programs, and collaboration with federal agencies and state medical boards.
If you violated state prescribing or dispensing requirements involving controlled substances, the DEA is likely aware. State and federal authorities commonly share information. While some states work closely with the DEA, others may only do so on an as-needed basis.
The scope of practice for nonveterinarians working with controlled substances also varies by state. States define the levels of supervision of assistants and credentialed technicians differently. For example:
- Permitted roles: Certain states, like California, prohibit someone from working with controlled substances unless specifically licensed or permitted to do so at the state level.
- Tasks permitted: Some states allow registered technicians to administer but not dispense controlled substances. Connecticut is one example, while other states are more lenient.
State-Scheduled Drugs
A state’s authority to enact controlled substance regulations that exceed federal requirements also extends to drug classifications. Just because a drug isn’t federally scheduled does not mean the medication is exempt from potential diversion or illicit use. States that believe a non-federally scheduled drug poses a threat or requires additional regulations may classify it as a controlled substance within that state.
For example, these substances are common drugs of concern:
- Gabapentin: Schedule V in Alabama, Kentucky, North Dakota, Tennessee, Virginia and West Virginia.
- Xylazine: Florida classifies xylazine as a Schedule I controlled substance. Delaware, Ohio, New Jersey, Pennsylvania and South Dakota list it as Schedule III, West Virginia as Schedule IV, Rhode Island as Schedule V, and Massachusetts as Schedule VI. (Xylazine legislation is pending in multiple states.)
Navigating controlled substance regulations involves a certain level of complexity. You must understand and comply with federal baseline requirements, adhere to state regulations and recognize state guidelines that are more stringent. DEA registrants cannot say, “I didn’t know.” It’s not a valid defense.
DEA registrants also must set an example for their teams by teaching the rules and guidelines. Yes, they are complex, but so are the medical cases that practitioners often deal with.
Think of DEA and state regulations as a challenge you are ready to take on. When you are uncertain, don’t be afraid to ask for help. Your state veterinary medical association, pharmacy board and regulatory board are resources to ensure you handle controlled substances correctly.
SEPARATION REQUIREMENTS
Veterinary teams must separate federally scheduled controlled substances from non-federally scheduled drugs and products. The rule also applies to medications scheduled at the state level only. Separation includes:
- Storage: Federally scheduled controlled substances may not be commingled in secure storage and must be physically separated from other drugs.
- Inventory: DEA controlled substance inventories must be documented separately from non-federally scheduled drugs.
- Records: All controlled substance invoices and DEA-required records must be maintained separately from other documents and records.
- Logging: DEA controlled substances must be logged separately from all other drugs.
- Reporting: DEA controlled substances are subject to specific reporting requirements. At the state level, remember to follow prescription drug monitoring program reporting requirements specific to veterinarians.
REGULATORY RESOURCES
- Federal controlled substances in alphabetical order: bit.ly/3W2kQ4h
- American Association of Veterinary State Boards Regulatory Board Look-Up: bit.ly/4q86gWA
- State veterinary medical associations and allied groups: bit.ly/46OUFo3
- National Association of Board of Pharmacy’s state board locator: bit.ly/4q86bCg