How the DEA Got Doctors Under Its Thumb Through Creeping Bureaucracy

Yesterday, in my piece on Massachusetts doctors fretting over risking their medical licenses by recommending medical marijuana. I wrote, "[p]rescription powers are strictly regulated by the DEA." I was called on that statement by commenter, Robert, which surprised me, since my experience is that my wife has to provide her DEA number every time she deals for the first time with a pharmacy, which then keeps it on file. As it turns out, the DEA technically has authority only over prescriptions for controlled substances. In reality, though, the DEA number has come to be the Social Security number of the health care industry — a nudge-nudge, wink-wink, non-universal identifier required so widely that it's increasingly difficult to practice medicine in its absence.

Officially, the Drug Enforcement Administration is oh-so-opposed to the use of DEA registration numbers on prescriptions other than those for controlled substances. On its site, the DEA says:

DEA strongly opposes the use of a DEA registration number for any purpose other than the one for which it was intended, to provide certification of DEA registration in transactions involving controlled substances. The use of DEA registration numbers as an identification number is not an appropriate use and could lead to a weakening of the registration system. Although DEA has repeatedly made its position known to industries such as insurance providers and pharmacy benefit managers, there is currently no legal basis for DEA to prevent or preclude companies from requiring or requesting a practitioner's DEA registration number.

In fact, as early as 1992, the Texas Medical Association complained about the practice of insurance companies requiring DEA numbers before they'd reimburse for prescriptions. In 1997, optometrists complained that they couldn't get any prescriptions filled without DEA numbers — and they weren't always eligible for DEA registration. Some state laws have been open to interpretation about whether DEA numbers are required for all prescriptions. Doctors in general continue to grumble about being hit it up for their DEA numbers for general prescriptions, but then they turn them over anyway.

How this happened, I don't know for sure. I can guess that insurance companies, having to track controlled-substance prescriptions by DEA number, found it easier to use those numbers as universal IDs than to play around with several different identifiers. Pharmacies followed suit to minimize checkout-counter debates with patients about reimbursement. And now medical practices require newly hired providers to have DEA numbers, because what's the point of employing a doc or nurse practitioner whose prescriptions won't be filled or reimbursed?

I'm sure there are still physicians, probably long-established, who get by without DEA numbers. They don't prescribe controlled substances. They deal with local pharmacies that know them and don't require DEA registration. And they let their patients worry about the tab.

But that has to be a vanishing breed.

This morning, I asked a pharmacist at a local branch of a big chain about DEA numbers. I got a hairy eyeball and fully expect to have to produce an ID the next time I buy toothpaste. He told me they "don't yet" require DEA numbers for non-controlled prescriptions, but the system is set up for it and he expects the requirement to come "any time now."

No law ever gave the DEA such wide authority over the medical profession. But it now has the ability to cripple medical careers by denying or yanking one simple number. Behold the power of creeping bureaucracy.