The Drug Enforcement Administration (DEA) has too much time on its hands. At least, that’s how it might seem to some veterinary professionals.

Jack Teitelman, retired DEA supervisory agent and current chief executive officer of DEA compliance experts Titan Group, told NEWStat that the DEA is shifting some of its focus from its high-profile efforts to battle the opioid crisis to scrutinizing compliance at veterinary hospitals.

“In the past, [the DEA] targeted pain clinics and pharmacies and distributors that were not adhering to the compliance standards,” Teitelman said, referring to the DEA’s efforts to identify and shut down so-called pill mills, meaning clinics, pharmacies, and physicians who prescribe prescription narcotics for nonmedical or inappropriate reasons. And because they spent so much time on pill mills, “they’ve pretty much wiped them out.”

The same applies to the opioid crisis in general.

While that crisis is definitely ongoing, Teitelman said the DEA’s suspicious-order monitoring programs have been very effective in identifying the bad actors—such as unscrupulous pharmaceutical distributors and shady pharmacies—that are instrumental in contributing to the crisis. “That’s pretty much under control,” Teitelman said. “Under control enough that they actually have a handle on how those drugs are moving through the system so they can track them better.”

So, basically, the DEA came up for air, looked around, and what did they see?

Veterinary hospitals. And the DEA dived right back in.

“[The DEA] is concentrating on doing surprise audits on veterinary hospitals,” Teitelman said. “They’re doing more than they’ve ever done before.” Although the DEA does not post statistics on the number of audits it performs, anecdotal evidence supports Teitelman’s assertion.

Teitelman notes that suspicious order monitoring and the full-court press on pill mills were official DEA policy: “This is different.” It’s not official policy, he said, citing conversations with former agency colleagues—it’s expedient. 

“The DEA looks at veterinary hospitals as low-hanging fruit,” said Teitelman.

The reason why

According to Teitelman, many veterinarians have become complacent about compliance because, for a long time, veterinary hospitals weren’t on the DEA’s radar. Teitelman says that when he talks to veterinarians at conferences, they often dismiss warnings about lax compliance with some variation of “the DEA’s never come to my facility in 20 years, so what do I have to worry about?”

Teitelman calls it an education issue that’s been going for decades: Controlled substance compliance wasn’t something people in the profession really discussed. “The DEA was like the boogeyman, and people were afraid to talk about it,” he said.

Even if veterinarians had questions about compliance that the DEA could answer, they’d be reluctant to contact the agency for fear of arousing their interest and possibly sparking an audit. “The attitude was, ‘What are we going to do, call the DEA and call in a bomb strike on ourselves?’ The inherent thought process has been to just keep quiet and keep your head down; they’re never going to come see us anyway, they’re only concerned about the human hospitals.”

“Well, we know that’s just not true anymore,” Teitelman said.

With the growing corporatization of the veterinary profession, the corporations that own multiple veterinary hospitals want to look more, well, corporate. “They want to look like [human hospitals],” said Teitelman. And the DEA expects the same rules and responsibilities that apply to human hospitals to apply to veterinary hospitals, so, “you better be handling your controlled substances the same way.”

Teitelman said the most common mistake veterinary hospitals make when it comes to compliance is recordkeeping.

“Recordkeeping is absolutely number one,” he said. It’s often just a case of [hospitals being] understaffed and overworked. “Most of the errors are human error [or] mathematical issues.”

“Every hospital at any given moment . . . would fail an inspection on their recordkeeping,” Teitelman said. When Titan Group audits veterinary hospitals, they find incomplete recordkeeping at most, meaning “most would get a violation.”

“It goes back to the fact that, [for years], no one [at the DEA] was paying attention to veterinarians unless something was brought to their attention.” Teitelman said veterinarians had nothing to do with the opioid crisis—but they were caught in the middle because of extralabel use of human drugs that are part of the problem. “Hence, their lack of protocols and oversight has exacerbated the situation.” And when one of those situations goes viral, “it makes the public and the government wary about the [veterinary] community as a whole.”

The bottom line: things have changed, and the days of veterinarians flying under the radar are long gone.

Today, the DEA uses data analytics to track compliance. “The government is looking at everyone’s prescription patterns. They’re looking at your ordering patterns. They’re not discriminating.”

Consider the case of a busy referral hospital in a big city that orders a ton of drugs: “They’re going to be looked at like everybody else because of data analytics. That didn’t happen before. It’s happening now.”

In an age of analytics-enforced transparency, there’s nowhere to hide.

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