DEA Registration & Compliance for Relief Veterinarians

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. So let’s address these questions head on, and help break the cycle of worry and anxiety that normally comes with talk of the DEA!

Once again, we did our helpful Roo thing and organized another (now annual) free webinar on DEA Registration for Relief Vets presented by industry leaders, Dr. Peter Weinstein and Kelley Detweiler. You now can watch a recording of our latest webinar at any time by clicking below or read on for a summary of what was covered:

‍

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. 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 level 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.
• 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 only focused on veterinary DEA registrants crossing state lines with their own controlled substance inventory to treat their own patients and does not cover standard relief veterinarians who travel to various facilities to use that facility's controlled substances to treat their patients.

Every state is different, and state law supersedes federal law, so always know and adhere to your state requirements in addition to any federal 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. 

You can find state DEA information and prescription regulations by visiting your state veterinary board’s website (you might get directed to your local pharmacy board), calling your state Veterinary Medical Association, or by contacting Simple Solutions 4 Vets. KNOW YOUR STATE LAWS!

Why do I need a DEA registration? 

This is where the fun begins. Every veterinarian who orders, dispenses, prescribes, administers, or wastes a controlled substance needs to be registered with the DEA unless you’re exempt (you’re probably not). 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.

‍

Additionally, some hospitals on Roo require a DEA Registration to request their shifts. Often, these can be higher-paying shifts at emergency hospitals. 

Applying for a DEA Registration

This is where the fun begins. Below are some step-by-step guidelines for getting a DEA registration:

1. Sate Veterinary License and Controlled Substance Registration 

As a general theme here, the state always comes first. You’ll have to get your state requirements squared away before you can register for a federal DEA license. Here’s the order you should apply in:

1. State Veterinary License (must be active)
2. State Controlled Substance Registration
3. Federal DEA Registration

IMPORTANT: The personal details and address on your State Controlled Substance license and Veterinary License must match your DEA Registration! If these details are different, your DEA license could get declined or revoked, which is not fun. 

State Controlled Substance registration can take a long time so be sure to plan for this when scheduling shifts. You’ll have to complete this step BEFORE you can even begin DEA registration.

If you’re looking to get licensed in multiple states, Roo has put together excellent veterinary licensing guides to help you get your DVM license in 33 state and counting! 

2. Choose a principal location

Determine the principal location where you want to use your DEA registration. Below are some options and best practices (*keep in mind, you must also follow state guidelines, not included here):

Home Address

Most relief veterinarians use their home address as the principal location for their DEA registration. If you go this route, a few things to consider: 

• You’ll be able to prescribe controlled substances and administer in-house controlled substances at other locations within the same state,  but you CANNOT directly dispense them without registering at 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 your 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 included in the section titled “Address Line 2.” Some examples: 
    • The upstairs hall closet
    • Garage
    • Master bedroom closet
  • You can now change the address for your DEA Registration online relatively quickly. 
• You should ensure you have proper documentation in that specific location of your home (see step #3 below). 
• 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.
  • If you’re a mobile vet or are transporting controlled substances, they must be secured in transit, and they cannot be left in your vehicle overnight. 

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

You should always have these documents stored at the location listed on your DEA registration:

• DEA registration
• State veterinary 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?

Genera rule: you should have a separate DEA registration for every state you practice in where you intend to work with controlled substances.

‍

Changing Your Address

You can now change the address for your DEA Registration online relatively quickly. This can be helpful in a pinch if you need to work a shift in a different state but is not recommended. Each address change will be investigated as if it’s a new registration so you don’t want to be doing this too much. 

Be sure to check if the state you’re transferring to has their own state controlled substance registration as this would need to be completed before you can change your address and could delay your federal DEA registration.

DEA compliance processes 

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. 

Be aware of state-scheduled drugs. Many states have specific regulations around particular controlled substances such as Xylazine, Gabapentin, and even Propofol, which may not be regulated by the DEA. Remember, state law trumps federal regulation in most cases. 

Hospital relationships & facility protocols

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.
  • Make sure your patient records are clear and complete as you likely won’t be the veterinarian following up with future treatment. It’s important all controlled substance activity be documented, logged, and reported correctly.
• 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 that 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 in a 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. 

• Keep in mind: this might be uncomfortable if your prescription displays your home address if you registered using your home as your principal location.
• Can I prescribe using my own prescription pad? s
  • 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 pharmacies will ask for your DEA number for non-controlled substances. Just say no. You do not need to provide your DEA number or NIC number when ordering a non-controlled substance.
• Some states require you to register with a prescription monitoring program. This is an additional regulatory body that monitors the abuse of prescription drugs. 
• What to do with extra 222 Forms?
  • If you have extra copies of Form 222 and you’re retiring or transferring your DEA registration to a new address, these must be returned to the DEA office that oversees the area where you’re practicing.
  • Do not shred these forms or dispose of them in another manner. These forms are serialized and may have your address printed on them.

Final takeaways

• Veterinary DEA regulations are a gray area — when in doubt, take the safest route!
• 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 our Professional Support resources page or reach out to Simple Solutions 4 Vets with specific questions.

‍

Want to help make a change?

Simple Solutions for Vets is in search of personal stories for how your ability to practice has been limited or impacted by DEA regulations. They’re compiling these specific examples to hopefully make changes to veterinary DEA regulations and help vets everywhere! You can email your stories to Dr. Weinstein and Kelley using the link above.

Disclaimer

With any federal agency, much of what is written is open to interpretation. The DEA’s guidelines are the Code of Federal Regulations, Title 21, 1308 to end. This article includes suggested best practices to meet or exceed the guidelines, but it’s up to you to understand and comply with these guidelines. 

These guidelines come from Simple Solutions 4 Vets who have shared and discussed this information with investigators and agents in the field to see how they will be enforced.

State regulations vary substantially and are not covered in this article. Make sure you know your local regulations!

‍

‍

Originally Posted 12/11/23