David Denio, PharmD, BCPP
Salt Lake City, UT
Obtaining a Controlled Substance Registration Certificate (DEA license) was encouraged by my site in order to help better serve our patient population. There are many practice settings where this would be useful for a pharmacist. Currently I work in an outpatient mental health clinic, where I work collaboratively with a variety of health care providers including psychiatrists, social workers, psychologists, and nurse practitioners. Having this certification means I can use the full scope of my knowledge and apply it to practice. Potentially this could work well in other collaborative settings including inpatient treatment, depending on the role of the pharmacist. Below are some pros and cons to obtaining your DEA license.
|Able to prescribe controlled substances||Patients will ask for those substances, even when it may not be appropriate|
|Can show/track workload directly||Clinical coverage of other providers patients for refills of controlled substances|
|Can use controlled substance knowledge in a more hands-on manner||Increased liability|
|Greater diversity of patients may be treated|
|Knowledge that all safety monitoring is done prior to the prescribing of controlled substances|
Advantages and Disadvantages
As many of you have likely experienced, prior to obtaining my DEA license there were times I was thankful I did NOT have it. Some examples included when patients presented to me on treatment regimens that were not entirely recommended, such as long-term benzodiazepine use with PTSD. In cases such as this, because I could not prescribe benzodiazepines, we could focus on adjusting more appropriate treatment modalities. With the DEA license, my practice has shifted; now I have the discussion on tapering potentially inappropriate medication (and can provide the taper itself).
Another change to my practice is providing controlled substance prescribing coverage when other providers are out of office. Patients may need renewals or new prescriptions for controlled substances. As a pharmacist I’m confident in my ability to thoroughly check monitoring of these controlled substances including reviewing the chart for documentation of stability, engagement in treatment, up to date labs (such as urine tox screens), and reviewing the state controlled substance databases. I can feel comfortable that the patient has been thoroughly reviewed. Generally, I only write enough supply to bridge them to the next appointment and there are instances where I will not write a prescription. For example, when they have not been engaging in treatment, labs are not up to date, or the controlled substance database shows unexpected findings. There are also times where I will reach out to the patient for an appointment or further assessment instead of providing a prescription. I find that in being the prescriber, I can ensure all safety monitoring is completed. Prior to having my DEA license, I would have to contact other providers and ask them to obtain the safety monitoring or I was assisting them in interpreting results.
Changes in Patient Panel
One noticeable difference after obtaining the DEA license is that my patient panel became more diverse. Patients who would not have been added to my panel previously were now being assigned. For example, patients with ADHD, narcolepsy and insomnia are often treated with controlled substances. Now they can be seen regularly by a pharmacist without additional burden of finding another prescriber to write prescriptions at each visit.
Laws and Limitations
Different states have different laws, and it is important to know the rules of the state you are licensed in. For example: If you are practicing in Idaho you should have a copy of your MTM agreement ready to provide the Board of Pharmacy as you pursue a DEA license. If you are thinking about obtaining a DEA license (and have support from your practice site) first check with your local Board of Pharmacy. Some states require a separate controlled substance certification. For the federal license, the DEA website offers step by step guidance on how to apply and applications electronically (https://www.deadiversion.usdoj.gov/online_forms_apps.html). If you move, be sure to update your address and practice site with them. If you are a federal employee and plan to use the license at a federal facility, the DEA license fee may be waived.
There are an estimated 150 million Americans that live in an area with mental health treatment shortages.1 Having a DEA license with prescriptive authority may allow pharmacists to establish collaborative care in order to treat a greater variety of patients and help close this gap.