Administration and Leadership, Columns

Pro Bono: Unraveling DEA Regulations on EMS Use of Controlled Substances

Issue 10 and Volume 40.

To say that Drug Enforcement Administration (DEA) requirements for ambulance services and EMS providers are confusing is quite an understatement. Even for lawyers used to understanding complex laws and regulations, DEA regulations rank at or near the top of the list of hard-to-understand and complex regulations. For example, we weren’t able to find the words “ambulance” or “EMS” in them anywhere, at least as of the drafting of this article.

Ambulance services are able to register as mid-level practitioners with the DEA. DEA regulations define a mid-level practitioner as “an individual practitioner, other than a physician, dentist, veterinarian, or podiatrist, who is licensed, registered, or otherwise permitted by the United States or the jurisdiction in which he/she practices, to dispense a controlled substance in the course of professional practice.” Paramedics and EMTs aren’t able to individually register as mid-level practitioners with the DEA. And, exactly what ambulance services registered as mid-level practitioners are able to do is up to each state.

At the time of publication, there are 38 states that don’t allow ambulance services registered as mid-level practitioners to dispense, administer or order any type of controlled substance. It’s no wonder many ambulance services located in one of these 38 states don’t bother to register with the DEA as midlevel practitioners! It appears registration wouldn’t do the ambulance service any good, as it wouldn’t be able to do anything with the registration, anyway.

What ambulance services registered with the DEA as mid-level practitioners are allowed to do in the other 12 states varies. Some states require their own state-controlled registration; others don’t. With all these variations, it’s easy to understand why so many are confused by DEA registration requirements.

Many ambulance services obtain and administer controlled substances through their EMS medical director’s DEA number. If your ambulance service doesn’t have its own DEA number and isn’t from a state that gives an ambulance service the ability to obtain and administer controlled substances with its own DEA number, then this is how the service typically obtains those controlled substances. The ambulance service, the practitioner involved and especially the EMS medical director could all face potential liability if the ambulance service experiences a drug diversion. That’s why strong policies on safeguarding, securing and accounting for all controlled substances stored and used is an absolute must. EMS medical directors, agencies and the vast majority of practitioners all desire to comply with DEA regulations. But complying with drug control and security requirements can be challenging, and professional organizations representing EMS medical directors have been pushing the DEA for guidance for several years now. Until this guidance is issued, confusion on this issue is likely to continue.

Pro Bono is written by EMS attorneys Doug Wolfbergand Steve Wirth, founding partners at Page, Wolfberg & Wirth. This month’s column was written with the assistance of PWW attorney Christie Mellott, Esq. Visit the firm’s website at