EMS Predictions: Changes on DEA Controlled Substance Rules

ESO Staff

As one of the leading holders of EMS data in the nation, ESO maintains a unique perspective into trends and factors that promise to impact the industry in the months to come. Our experts formulate predictions for the year to come and share them in an annual Predictions publication. Included in the publication are suggested actions that can help agencies best prepare for the changes and trends on the horizon.

The 2019 EMS Predictions publication, which is free for download on the ESO website, examines four predictions that will most likely impact the EMS industry in the year to come, including a prediction regarding changes in controlled substance rules, driven by the U.S. Drug Enforcement Administration (DEA).

Changes to Controlled Substance Rules

EMS agencies are no strangers to the opioid epidemic that is causing serious damage in the United States; with 130 Americans die from opioid overdoses every day, the chances of an EMS agency responding to such a call continues to rise. Agencies are being asked to do more to prepare to document, respond, and properly treat opioid-related calls.

However, in 2019, EMS agencies will need to take this a step further by understanding and responding to DEA rule changes that are predicted to come into play in Spring 2019. The DEA will be modifying regulations related to the registration requirements of DEA registrants in regards to the transport and dispensing of controlled substances. The DEA will provide specific requirements for EMS agencies handling controlled substances, and as a result of these rule changes, EMS security, ordering, and recordkeeping will also have to change.

Addressing Diversion

In addition to getting more insight into the nationwide opioid crisis, another driving force behind new regulations is a reduction in “diversion,” defined as the act of diverting a controlled substance from its intended purpose, either at the time of administration or the time of wasting. Whether diversion is caused unintentionally (due to a lack of understanding of pain management protocol or dosing) or intentionally (sadly, EMS teams are not immune to the reaches of opioid addiction), careful monitoring of opioid administration trends within an agency can help give insight into any potential problems or outliers.

Trends Give Insight

A recent JEMS article outlined one Texas EMS agency’s approach to tracking and identifying potentially problematic diversion by reviewing and comparing administration rates over time, looking at individual providers’ rates of administration compared to team averages. By reviewing the rates across several months and watching for spikes or other outliers, the agency could easily identify and address any potential issues.

The agency created protocols on how to handle any concerning trends, whether is meant additional training on opioid administration and pain management protocols, or a face-to-face QA system and compliance questioning. The agency stressed that trends should be reviewed not for a single spike in opioid administration, but recurring trends over time.

Suggested Actions

As the upcoming DEA regulations promise to ask more of agencies in tracking and reporting, how can an organization get ahead of the curve? While agencies across the nation rely on a wide range of tools to record administration information, there are ways to make compliance easier and less painful for your organization and team members.

  1. Stay one step ahead of the regulations.
    Rules and regulations around opioids, data collection, and other controlled substances can change rapidly. Consider setting up Google Alerts on those keywords so you’ll have the most recent information delivered straight to your inbox. It is anticipated the new DEA proposed rules will be available for public comment in early spring 2019.
  2. Make data tracking easier and more actionable.
    Find tools that ensure you accurately collect and sort needed data, such as ESO Electronic Health Record (EHR). By documenting required data in advance, you’ll be prepared to understand and identify the right needs for controlled substance response in your area. Read the article, Spokane Valley Fire Officials Map Opioid Hot Spots, from Spokane Public Radio for an example of how opioid documentation can turn into actionable data.

By proactively collecting and reviewing data on your agency’s opioid administration practices, you can not only reduce your own instances of diversion, but be prepared to easily respond and comply with new requirements from the DEA.

To read the additional EMS predictions for 2019, including topics on payment reform, provider wellness and safety, and more, download the EMS predictions document now.

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