This column was originally posted on Jeff Keller’s blog, Jail Medicine.
I have found that many correctional practitioners, especially in jails, do not understand the license requirements of the federal Drug Enforcement Agency (DEA) and, as a result, do not have all of the DEA licenses they are legally obligated to obtain.
Take, for example, a correctional physician we will call Dr. K who is employed full time at a large urban jail and has had a DEA license for that jail for many years. On the side, she also provides medical services to three other smaller jails where she does clinics once a week. The question is whether her one DEA license covers her activities at the other jails. Dr. K has always thought she only needs one DEA license – just like she only needs one driver’s license – and it will cover all of her activities.
But the answer is, “No,” Dr. K is not in compliance with DEA regulations.
Separate DEA license required when controlled substances stored or distributed
The relevant law is titled 21 C.F.R. §1301.12(a). This law went into effect on January 2, 2007, so this is not new information!
The law states that: “A separate registration is required for each principal place of business or professional practice at one general physical location where controlled substances are manufactured, distributed, imported, exported, or dispensed by a person.”
What this means is that Dr. K is required to have a separate DEA license for each of the jails where she practices if controlled substances are stored or distributed at that jail. Most jails fit this description since they stock and dispense controlled substances like Valium or Ativan (used for alcohol and benzo withdrawal) and Tylenol with Codeine or tramadol (used to treat pain), etc. This means Dr. K must obtain a separate DEA license for each jail where she provides services. Since she provides services at four jails, she needs four DEA licenses, each listing the specific jail’s address.
That is not all, however! Some states require a controlled-substance license that mirrors the DEA license. If Dr. K lives in Idaho, for example, she also needs to have four state controlled-substance licenses for each of her four jails. (Look up your state’s requirements here).
Even though this DEA law has been in effect for over 12 years, I have found few practitioners are aware of it. When they do learn of the requirement for multiple licenses, the first reaction is often, “Wow, that’s expensive!” Yes, each DEA license costs (currently) $731 for a three-year license. That can add up quickly. In Idaho, add $60 a year for each of the state controlled-substance licenses and pretty soon we’re talking real money!
“Isn’t there some loophole?” I hear you ask.
Well, 21 C.F.R. 1301.12 does indeed have an exception, but it won’t help Dr. K. The law states you don’t have to get a separate DEA license at any practice location where “controlled substances are prescribed but neither administered nor otherwise dispensed . . . and where no supplies of controlled substances are maintained.” This perhaps would apply to an urgent care center where a practitioner may write a controlled substance prescription but nothing is stocked and so the patient must fill the prescription elsewhere. However, this does not apply to most jails, because controlled substances are almost invariably stored on-site at the jail.
DEA licenses are state-specific
A final regulation of 21 C.F.R. 1301.12 states that DEA licenses are state-specific. Practitioners must have a separate DEA license for each state in which they practice. This means that even if Dr. K is filling shifts at a Doc-In-the-Box that normally would be covered by the DEA license exception noted before if that location is in another state, she must obtain a DEA license for that new state. This requirement can be especially burdensome for locum tenens practitioners. The DEA even acknowledges this: “DEA recognizes that the requirement to have separate DEA registrations for each state imposes a burden on practitioners who practice in multiple states.”
Well, I guess the DEA is not there to make our lives easier! As difficult as it may be, all correctional practitioners need to obtain all of the DEA licenses they are legally obligated to have.
As always, what I have written here is my opinion, based on my training, experience and research. I could be wrong! If you think I am, please say why in the comments!
This article was originally published in CorrDocs, Fall 2019.
