Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A DEA agent explains how to fight the opioid crisis and mitigate DEA risk

Dennis Wichern
Meds
June 4, 2018
197 Shares
Share
Tweet
Share

42,000. That’s the number of CDC reported overdose deaths in 2016 due to opioids.

Ten percent. That’s the percentage of the estimated 2.1 million opioid substance abusers receiving treatment help and even fewer afforded medication-assisted treatment (MAT) for their struggles.

Three percent or around 40,000. That’s the number of physicians out of a total of 1.3 million across the U.S. qualified by the Substance Abuse and Mental Health Services Administration (SAMHSA) to treat opioid dependence with buprenorphine in various medical office settings.

Eight hours. That’s the amount of time it takes to be qualified to treat substance abusers with MAT after completing a SAMHSA training class.

2018. That’s the year you no longer fear MAT or DEA.

Now, stick with me as I explain why this is important, how we got here, and how to navigate MAT risk- free to help combat opioid dependency — from a lifelong DEA agent.

SAMHSA oversees MAT for opioid dependence, while DEA supports their efforts through the regulation and oversight of controlled narcotic substances approved by the Food and Drug Administration (FDA). Sublingual buprenorphine was first approved for clinical use in 2002 by the FDA and in combination with counseling and behavioral therapies, allows qualified physicians the ability to treat those with opioid dependence in an office-based setting known as “office-based opioid treatment.”

Buprenorphine combined with naloxone, buprenorphine alone and long-acting implantable buprenorphine; methadone; and naltrexone have all been approved by the FDA for use in MAT.

Back in 2004, SAMHSA published TIP 40 titled, “Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction: Treatment Improvement Protocol (TIP) Series 40,” which indicated that patients seeking treatment for opioid dependence were first inducted with buprenorphine medication in a physician’s office to determine the appropriate dose before a prescription was written. Most providers back then maintained an inventory of buprenorphine in their offices for dispensing and induction.

In keeping with requirements under the Controlled Substances Act (CSA), the DEA began conducting buprenorphine recordkeeping inspections of MAT providers starting around 2006. Many of these providers failed the inspections due to a lack of education and understanding regarding recordkeeping requirements for buprenorphine dispensing.

As you could imagine, these inspections went over as well as a patient’s first colonoscopy.

Those who failed the inspections were given innocuous Memorandums of Agreements or Letters of Admonition by DEA and instructed on proper recordkeeping requirements. Nonetheless, these buprenorphine inspections struck fear in many providers and frequently caused a negative view of DEA and MAT.

Let’s fast forward to 2018 when the recently released and updated treatment protocols from SAMHSA have streamlined and simplified the induction process for MAT providers. SAMHSA’s recent publication, “Medications for Opioid Use Disorder For Healthcare and Addiction Professionals, Policymakers, Patients, and Families – Treatment Improvement Protocol 63” states “Office-Based Induction Providers can perform office-based induction by ordering and storing induction doses in the office or by prescribing medication and instructing patients to bring it to the office on the day of induction.”

Think simple and smart, not hard. A prescription is simple and speaks for itself. Ordering, storing and dispensing controlled substances, along with a litany of recordkeeping requirements is hard, cumbersome, and slow.

Let’s keep it simple and virtually risk-free. Prescribe only and do not maintain any controlled substance. Period. This is my risk mitigation tip #1.

DEA’s only door into your medical practice is through controlled substances. If you can operate without maintaining controlled substances, by prescribing only, you effectively close the door from DEA ever inspecting your office.

My risk mitigation tip #2 is to follow a national MAT guideline like SAMHSA TIP 40, SAMHSA TIP 63 or ASAM’s 2015 National Practice Guideline.

Lastly, if you do have to maintain controlled substances ensure that your records are complete — think checkbook register. Records should include an initial inventory, biennial inventory, closing inventory, the maintenance of receiving records (minimum two-year federal retention; your state could be longer), distribution records, theft and loss reports if any, and drug destruction records if any.

Now, let’s all help save a life and a nation from opioid addiction.

Dennis Wichern is a retired DEA agent.

Image credit: Shutterstock.com

Prev

Finding a new doctor is like dating

June 3, 2018 Kevin 14
…
Next

The quandary of cost transparency

June 4, 2018 Kevin 6
…

Tagged as: Pain Management, Primary Care

Post navigation

< Previous Post
Finding a new doctor is like dating
Next Post >
The quandary of cost transparency

More by Dennis Wichern

  • CBD: What is it? A former DEA agent explains.

    Dennis Wichern
  • Telemedicine should be easy. Here’s why it’s not.

    Dennis Wichern
  • How to avoid negative press and fines during the opioid crisis

    Dennis Wichern

Related Posts

  • CBD: What is it? A former DEA agent explains.

    Dennis Wichern
  • Fight the opioid crisis with physician assistants

    James Cannon, PA-C
  • The risk physicians take when going on social media

    Anonymous
  • The other opioid epidemic that we ignore

    Hans Duvefelt, MD
  • The opioid crisis: Doctors cannot lose hope

    Linda Girgis, MD
  • Marijuana will not fix the opioid epidemic

    Kenneth Finn, MD

More in Meds

  • The real cause of America’s opioid crisis: Doctors are not to blame

    Richard A. Lawhern, PhD
  • Can personalized medicine live up to its hype in health care?

    Ketan Desai, MD, PhD
  • The effects of the nationwide stimulant shortage on a private psychiatry practice

    Christine Tran-Boynes, DO
  • Why North American medical cannabis can’t compete globally

    Michael Sassano
  • How were we duped and what can we do about the opioid overdose crisis?

    Ronald A. Zent, MD
  • Caught in the middle: How health insurance companies influence cancer drug selection

    Paul Pender, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Breaking free from gaslighting [PODCAST]

      The Podcast by KevinMD | Podcast
    • The pros and cons of using ChatGPT for your health care needs

      Liudmila Schafer, MD | Tech
    • Dr. Glaucomflecken for president!

      Aaron Morgenstein, MD & Amy Bissada, DO & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Do residents deserve the title of physician?

      Anonymous | Physician
    • A new era of collaboration between AI and health care professionals

      Harvey Castro, MD, MBA | Tech

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • How Did Pulse Oximeters Perform in Black Kids?
  • Coffee and Heart Function; Ionizing Radiation and CVD
  • Health Inequity Should Be Labeled as a 'Never Event'
  • Healing the Damaged Nurse-Physician Dynamic
  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Breaking free from gaslighting [PODCAST]

      The Podcast by KevinMD | Podcast
    • The pros and cons of using ChatGPT for your health care needs

      Liudmila Schafer, MD | Tech
    • Dr. Glaucomflecken for president!

      Aaron Morgenstein, MD & Amy Bissada, DO & Corinne Sundar Rao, MD | Physician
    • What is driving physicians to the edge of despair?

      Edward T. Creagan, MD | Physician
    • Do residents deserve the title of physician?

      Anonymous | Physician
    • A new era of collaboration between AI and health care professionals

      Harvey Castro, MD, MBA | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

A DEA agent explains how to fight the opioid crisis and mitigate DEA risk
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...