At 6:15 a.m. on a Thursday in February, a practice owner texted me this: “Urgent! Please call! Emergency situation!” The veterinarian, who was also the hospital’s Drug Enforcement Administration registrant, later told me that three DEA diversion investigators conducted an unannounced inspection the previous day after an unusually large order of controlled substances was placed under her registration. A distributor flagged the order as suspicious.
When the DEA asked about it, the registrant responded: “I had no clue. I haven’t placed orders in years. My staff handles ordering.”
Note: Wrong answer! Strike one.
When the DEA asked whether a power of attorney was in place for the individual ordering Schedule II controlled substances, her response was, “I didn’t know I needed one.”
Note: Wrong answer! Strike two.
When the DEA asked why the registrant didn’t handle controlled substance orders herself, she said she didn’t know of any veterinarians who had time for ordering. She also admitted that she had never logged into the online ordering platform.
Note: Volunteering information on top of a bad answer can worsen a situation.
When the DEA asked whether she had required background checks or drug testing for individuals authorized to order or work with controlled substances, the registrant said “no” because she “liked to give opportunities to individuals who had a hard time finding a job and frequently hired individuals living in halfway houses.”
Note: A terrible answer!
After reconciling the controlled substance logs against the physical inventory, one of the DEA investigators asked whether the registrant was aware that over 40 tablets were missing from a bottle. The registrant said she was not. The investigators also found multiple containers of controlled substances never used to treat patients, along with three bottles that had been dispensed and commingled with the inventory. When questioned, the registrant said she had no idea where any of it came from.
Note: Wrong answer! Strike three.
The registrant commented that she would have questioned things had she not been so busy trying to keep her practice afloat.
Note: A response like that hands the DEA more rope with which to hang you.
The registrant said not knowing how to manage controlled substances wasn’t her fault because she didn’t learn about DEA requirements in veterinary school. She added that drug diversion occurred twice when she was a student but that her school’s instructors told her not to say anything because the issue would be handled internally.
Note: The rope now has a noose. Game over.
Let’s dissect her responses one by one.
“I didn’t know. No one told me.”
DEA registration is a privilege, not a right. The federal agency grants qualified individuals a DEA registration and can take it away. “I didn’t know” and “No one told me” aren’t acceptable answers. The DEA Practitioner’s Manual outlines the responsibilities and requirements that come with the privilege of having a practitioner’s registration.
The assistant administrator of the Diversion Control Division clearly states on Page 7 of the Practitioner’s Manual, “Your role in the proper prescribing, administering and dispensing of controlled substances is critical to the health of patients and helps protect society against drug abuse and diversion.”
Not reading the manual, just like not knowing your state’s veterinary practice act, isn’t a defensible argument.
“I’m too busy.”
The DEA doesn’t care how busy you are. According to the Code of Federal Regulations, one of your primary responsibilities as a registrant is to “provide effective controls and procedures to guard against theft and diversion of controlled substances.”
The comedian Kevin Hart is quoted as saying, “I don’t care how busy I am; I will always make time for what’s important to me.” Not making time to read and understand the Practitioner’s Manual, the Controlled Substances Act and Title 21 of the Code of Federal Regulations tells the DEA that drug compliance isn’t important to you.
“We’ve always done it this way.”
That excuse comes up a lot. And it comes up for good reason because the veterinary industry did things a certain way for a long time and flew under the DEA radar. All that changed when the opioid crisis spilled over from human health care to veterinary medicine.
Times have changed, and DEA registrants are responsible for keeping up with changes. You must be diligent about learning new laws, staying current on federal regulations, and knowing your state’s veterinary practice and pharmacy acts.
Stop focusing on the rearview mirror. Look through the windshield.
“It’s never going to happen to me.”
Thinking the DEA won’t show up at your veterinary practice is a choice to operate in ignorance. “It won’t happen to me.” Wrong! The minute you think like that, an inspection likely will happen. Ignorance is not bliss to the DEA.
“They didn’t teach this in veterinary school.”
Unfortunately, veterinary medicine schools don’t always provide sufficient guidance on DEA responsibilities. Pharmacology is taught as part of the core curriculum, but the focus is more on the drugs routinely used in clinical situations. There’s also a discussion about writing prescriptions into the medical record and giving one to a client. Many schools have law classes on legal issues facing the profession. However, much of what you learned is buried deep inside your brain by the time you’re working in the clinical world.
You enter a regulatory minefield when you apply for a Drug Enforcement Administration registration. It’s time to sign up for the continuing education you need to be compliant with regulations and prevent diversion.
“It’s not my fault. I wasn’t there.”
As a DEA registrant, you must be a physical presence and ensure proper oversight of your controlled substance inventory. The onus is on you. Telling the DEA, “It’s not my fault,” is an admission that you don’t understand your role and responsibilities.
“How could I have known?”
The Drug Enforcement Administration will always tell you it’s your responsibility to know. When you accept the privilege of becoming a DEA registrant, your job is to know. You’re legally obligated to implement adequate controls and oversight over the management of your inventory of controlled substances.
You should have known.
The Aftermath
Here’s what became of the case involving the early morning text message:
- The DEA didn’t care that the veterinarian registrant didn’t place the suspicious order.
- The DEA didn’t accept her response that she didn’t know how to access her controlled substance ordering platform and that she couldn’t explain the inventory discrepancies.
- The DEA didn’t care that she hadn’t learned all the rules when she was in veterinary school.
The diversion investigators departed with her DEA registration, her entire controlled substance inventory and her logbooks. The DEA also called the state boards to demand revocation of her ability to practice veterinary medicine. She is awaiting formal legal proceedings.
Don’t make the same mistakes that this registrant did. The errors are avoidable. Don’t strike out. Your team needs you to stay in the game.
Simple Solutions for Vets founder Dr. Peter Weinstein contributed to this report.
ONLINE RESOURCES
- Practitioner’s Manual, bit.ly/3OHn71t
- Code of Federal Regulations, bit.ly/3Oz345p