DATE:June 23, 2010

TO:ASCP Advocacy Council

FROM:Lynne Batshon, Associate Director for Government Affairs, and John Feather, Executive Director and CEO

SUBJECT: Meeting with NABP on DEA Issues

ASCP remains deeply engaged in the effort to resolve the long standing issues of the use of pain medications in long-term care facilities, especially in light of DEA enforcement actions over the past year. We work with many organizations on these issues, among them the National Association of Boards of Pharmacy (NABP). At the March 24, 2010 U.S. Senate Special Committee on Aging listening session chaired by Sen. Herb Kohl of the Senate, NABP offered to work with stakeholders and the DEA to create a possible remedy through the process of developing a new registration category for nursing facilities.

In the subsequent weeks, a number of rumors began to circulate about this effort, as well as confusion over public statements made by various groups. In an effort to better understand the current status of NABP’s efforts, the ASCP Executive Committee, the chair of the ASCP Advocacy Council, and ASCP staff met with Carmen Catizone, NABP Executive Director, and William Winsley, Executive Director of the Ohio Board of Pharmacy and current president of NABP.

One important message we received was that there are currently three independent but related efforts being undertaken by NABP or the individual state boards of pharmacy. Some of the confusion we have heard from the field relates to the lack of clarity about these efforts, which include:

  • NABP’s current efforts to move forward with individual states to create a new DEA registration category;
  • A new NABP task force to examine the Controlled Substances Act; and,
  • An effort in Ohio to create a model that might be used in other states.

NABP’s current efforts. The concept proposed by NABP involves the development of a new category of DEA registration for nursing facilities that would allow them to function in a similar manner to hospitals. NABP believes this approach to be the most expedient and efficient manner to achieve the objective sought by the long-term care industry: recognition of nurses as the agent of the prescriber and recognizing chart orders as valid prescriptions.

Carmen explained that some states, such as Maryland and North Carolina, already have regulations that authorize some long-term care facilities to acquire DEA registration, which allows them to dispense controlled substances and own their own stock. Wisconsin is about to introduce a bill that would permit DEA registration of nursing facilities. NABP is in the process of polling all states to see what if any have regulations authorizing nursing facilities to dispense controlled substances and which states would require new legislation in order to grant such authority. The survey will also assess which regulatory body within each state is charged with granting authorization to dispense controlled substances. This survey is expected to be completed within two weeks.

NABP Task Force. At its annual meeting in May, NABP created a formal task force to review the Controlled Substances Act in its entirety and propose revisions as necessary. This would be a multi-year program and would include a process to include a wide variety of stakeholder groups. Proposed updates would be consistent with current technologies and other changes in culture and business models that have taken place in long-term care since the enactment of the CSA. DEA has indicated it is interested in working with NABP and the task force. While this could be an important long term strategy, it would not have an immediate or short term impact on the DEA issues.

Ohio Activities. Bill Winsley is discussing with an ad hoc group of several long-term care pharmacists and a corporate nursing facility chain in Ohio how a new category of registration for nursing facilities might work. He feels that since these recent problems began in Ohio, the development of a solution should be initiated in Ohio. A draft statement is currently circulating for review and comment within the ad hoc pharmacy group in Ohio. Within the next week, Bill will review the comments received from the pharmacy group and revise the proposal as necessary before submitting it to DEA staff for review within the next few weeks. After being reviewed by them, the model will then be shared with other states, through NABP, for review and possible consideration.

Many issues remain to be resolved, and along with our allies in the long-term care pharmacy world, ASCP is working hard to improve the care provided to patients in pain. ASCP is working with many stakeholders to provide accurate and timely information, and we hope this brief report is helpful in providing information.