DEA: Separate registration for multistate practices

Physicians who prescribe controlled substances and practice in more than one state soon could have more fees to pay, more paperwork to fill out and more numbers to identify themselves by.

The U.S. Drug Enforcement Administration wants these physicians to obtain separate DEA controlled substance prescribing registration for each state in which they practice, according to an item posted in the Federal Register on Dec. 7, 2004. Although the amendment is supposed to clarify existing regulations, one physician who practices in western Kentucky and southern Illinois said it would cause only headaches and confusion.

"It is definitely not the greatest thing in the world, and I don't see how it will have any advantage at all," said Laxmaiah Manchikanti, MD, medical director of the Pain Management Center of Paducah and the Ambulatory Surgery Center of Paducah in Kentucky. "I don't know why the DEA is so worried about this. It should keep the system the way it is."

It is very common for Kentucky physicians in Paducah or Louisville to also practice in Ohio, Indiana or Illinois, said Dr. Manchikanti, who is president of the American Society of Interventional Pain Physicians. He estimated that about 20% of the society's 3,000 members practice in more than one state.

Dr. Manchikanti said this was not just a concern for pain specialists. He said the change also would affect primary care physicians, psychiatrists and pediatricians.

The Federal Register stated that the DEA would take public comments on the proposed rule change until Feb. 7. There were no other dates or schedule information given related to the proposal. "The process will take whatever time is required," said DEA spokeswoman Rogene Waite. "DEA does not impose timelines."

The AMA said it was reviewing the proposal and, although it did not have an official comment at this time, it did plan on submitting comments before the Feb. 7 deadline.

Jeff Gilbert, spokesman for the Pharmaceutical Research and Manufacturers of America industry group, said his organization also was reviewing the proposal but had no comment at this time.

Money is not the issue

On Dec. 1, 2003, the DEA raised its registration fee for physicians from $70 to $131, but Dr. Manchikanti said his problem with the proposal was not the money. He said it's the registration process, which can take two weeks or more. He also predicted problems such as physicians accidentally writing the wrong registration number or patients receiving unwarranted law enforcement scrutiny because they received a prescription in one state and filled it in another.

The DEA's Federal Register posting stated that each DEA registration was always intended to be applied only for offices within one state and that the proposal was being made in order to avoid "further misinterpretation."

"DEA proposes to amend its regulations to make it clear that when an individual practitioner who practices and is registered in one state and seeks to practice and prescribe controlled substances in another state, he/she must obtain a separate DEA registration for the subsequent state," the Federal Register stated.

In explaining the need for separate registrations, the DEA noted that registration serves to reflect that a certain state has granted a doctor "some level of controlled substance authority" and that registration is considered to be "related directly and exclusively" to an individual state license.

In explaining the need for maintaining this direct relationship, the DEA noted that state prescribing laws can differ.

Scott Fishman, MD, chief of the Division of Pain Medicine and associate professor of anesthesiology at the University of California, Davis, and president-elect of the American Academy of Pain Medicine, said the proposal "sounds like it's reasonable" on its surface, but he questioned the DEA's motives and intentions in light of a recent deterioration in the agency's relationship with physicians.