Decoding theD(rug) E(nforcement) A(dministration) – Horse and Rider

Learn why certain medications are under lock and key, and why your vet works hard to make sure they are available for your horse.

It’s no secret that the misuse of medications has become a public health crisis. In fact, the opioid epidemic makes headlines almost daily due to growing numbers of overdose deaths. So, what does this have to do with you and your horse? More than you might think.

In fact, fentanyl, widely considered the world’s deadliest opioid, has become even more dangerous as it is being mixed with xylazine, a sedative that many equine veterinarians reach for multiple times per day.

It turns out xylazine enhances the effect of fentanyl and increases its value on the street. It also makes opioids like fentanyl even more dangerous, in part because it’s immune to the effects of the life-saving reversal drug naloxone (Narcan). That means the bottle of xylazine you keep in your tack trunk could easily contribute to an overdose death if it were to make it to the street.

Xylazine isn’t the only drug used in horses that can be dangerous to humans—it’s just one that has recently hit the news. Other medications that your vet regularly uses to treat your horse, including ketamine, used for short-term anesthesia, and sodium pentobarbital, used for euthanasia, can also pose a threat.

Enter the Drug Enforcement Administration (DEA), the government agency responsible for overseeing these potentially dangerous medications.

In this article, I’m going to answer any questions you might have about the DEA: what it is, how it functions, and why it matters. With this information in hand, it’ll be easier to understand why your vet says no to some of your medication requests, and how hard they work to make sure your horse still gets what he needs.

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The DEA: Your Questions Answered

What is the DEA?

The DEA is a government agency that oversees laws and regulations related to medications that require restrictions to protect public health. This oversight can impact your horse life by making it more difficult to get your hands on certain medications. But it’s also critically important for keeping people safe. The DEA’s mission also includes educating the public about medications and their potential impacts. As well as supporting programs aimed at preventing drug abuse.

Why are some medications “controlled”?

Medications are selected for DEA control based on whether or not they have a legitimate medical use, their potential for abuse, and safety concerns. Safety concerns include the likelihood that they will lead to either physical or psychological addiction in people who use them.

What are the different levels of controlled medications?

Controlled substances are divided into five separate categories, called schedules. Here’s how they are divided:

Schedule 1 medications are the most heavily controlled. They have a high potential for abuse, and the potential to create severe physical and psychological addiction. They also have no current, accepted medical use. Example: heroin. (Interesting note: marijuana is currently a DEA schedule 1 substance. More on that in a minute.)

Schedule 2 medications do have a current, accepted medical use, but a high potential for abuse and development of addiction. Examples: Vicodin (hydrocodone) and fentanyl.

Schedule 3 medications have a current, accepted medical use and moderate to low potential for abuse and addiction. Example: ketamine.

Schedule 4 medications have accepted medical use and low potential for abuse or dependence. Example: Xanax.

Schedule 5 medications require the lowest level of control, with the lowest potential for abuse or dependence. Example: Cough medications with low levels of codeine (i.e., Robitussin AC).

How can marijuana be legal in my state if it’s a DEA Schedule 1 medication?

Here’s where things get really confusing. Medication control is regulated on both a state and federal level, meaning different rules apply in different states. Marijuana is a perfect example of this scenario.

Although the DEA still maintains marijuana on the list of schedule 1 medications, it’s scheduled and managed differently in some states. It’s also helpful (and confusing!) to recognize that controlled substance lists are constantly changing based on new knowledge or information about different substances.

For example, it has become widely accepted that marijuana does have some legitimate medical use, and the DEA is currently considering a change to marijuana scheduling from schedule 1 to schedule 3. Meanwhile, state laws regarding marijuana use are actively evolving. This means laws surrounding control of marijuana are not only inconsistent from state-to-state, they’re also likely to change.

In the horse world, the situation with xylazine is similar. While xylazine was not previously scheduled at all, recent issues with this medication’s involvement in overdose deaths have led both the DEA and individual states to add it to controlled substance lists.

The balancing of federal and state laws, and the potential for medications to change in status, make is especially hard to keep track of what’s required for every individual medication.

What does it take for my veterinarian to have these medications on hand?

It’s more complicated than you might think. The first step your vet must take to legally prescribe any controlled medications is to apply for a DEA number, which requires state licensure and a permit or license to prescribe controlled substances in that state.

The process varies in every state, and even though the DEA is a federal agency, your vet must apply for a separate DEA license in each state where they intend to practice. It takes between four and six weeks to complete the process and costs just under $1,000. The application process is a serious matter, and the penalties for providing false information are severe—up to $250,000 or four years in jail.

Once your veterinarian has been issued a DEA number, they have to provide it to the distributors they work with in order to obtain any supplies of a controlled medication. And once they have the medication in their hands, the rules don’t stop. Recordkeeping and security for controlled substances is another thing your vet must take seriously.

Then…

Any scheduled medications must be stored in a secure lockbox, with access limited to a small number of people. This includes medications your veterinarian carries in their truck, which should be kept in locked drawer. Your vet maintains a controlled substance log that tracks where every drop of medication that’s administered or dispensed goes, and how it is given. At a final accounting, your vet must be able to match the amount of each medication that’s dispensed or administered to what they have obtained from their distributor. It’s a daunting recordkeeping task.

What happens if the accounting doesn’t match? Your vet can find themselves in big trouble. The DEA can perform an audit to check on compliance by anyone with a DEA number at any time, and insufficient or inadequate records are the most common violations reported. Fines are steep. Your vet could end up owing thousands of dollars in fines for being careless, and if large amounts of controlled substances go missing and can’t be accounted for, your vet could even go to jail.

It’s easy to see why managing controlled substances is one of every veterinarian’s greatest nightmares. It should also be easier to understand why they can’t just hand you a bottle, or even a dose, of a medication you’d like to have on hand if that medication falls under DEA control.

Do the changes mean xylazine will be harder to get?

Yes, it might. Problems associated with xylazine are widespread. In fact, fentanyl laced with xylazine has now been identified in 48 of 50 states, prompting the U.S. government to identify this drug combination as an emerging threat in the United States. That means xylazine has garnered a lot of attention from the DEA. And efforts to add it to controlled substance lists are growing. The good news is that reports indicate very little of the xylazine currently found on the street has been diverted from veterinary sources so far, and industry leaders have been working hard to ensure this medication will still be available for veterinary use. That said, there’s a good chance your vet will soon be required to closely track where xylazine goes—down to the last drop. Gone are the days when bottles of xylazine will be available to have on hand.

A Week in the Life

Now that you’ve heard the details about medication controls, let’s take a minute to follow the path of a controlled substance—starting from the time your veterinarian places an order with their distributor. We’ll also take note of where, and how, things can run amuck.

T-5 days

You schedule your youngster for a castration. Your vet prefers to perform this procedure with your horse under short-term anesthesia. That includes ketamine, a DEA schedule 3 medication. Your vet checks stock and places a ketamine order with their distributor.

(Note: Xylazine is also commonly used along with ketamine as part of the protocol to lay a horse down for a castration, as are diazepam and midazolam which both fall under the DEA’s schedule 4. For this example, we’ll focus our attention on the ketamine. Be aware, however, that all these steps described below are required for diazepam and midazolam, and may be necessary for xylazine as the rules evolve.)

T-3 days

The ketamine order arrives at your veterinarian’s office. It’s logged in the controlled substance inventory and locked away.

Red Flag warning: It’s critical that the person responsible for unpacking and putting ketamine away is completely trustworthy. All it would take for a bottle to end up on the street would be for someone to pocket this medication and take it home. That’s why access to the controlled substance lockbox needs to be limited to the most trusted personnel.

Red Flag warning: If your vet keeps controlled substances in their truck, it can be especially risky in case of a break in. Even locked drawers can be at risk—making it especially important that your vet keeps their truck secure.

T-0 days

Castration day! Your vet retrieves ketamine from the lockbox and administers 10cc’s to your horse (in addition to the other needed medications). Your yearling colt is now a gelding. The vet records the 10 cubic centimeters in their controlled substance log.

Red Flag warning: If your vet records 10 cubic centimeters but ends up using 12 because the horse needed a little extra to keep him asleep, your vet’s controlled-substance logs won’t be accurate. This can become a problem when it comes time to match amounts used with what should be in inventory. Even a couple of cubic centimeters matters.

T+15 days

The end of the month rolls around. Your vet is very careful with controlled substance tracking and matches up their logs each month. They match the ketamine they administered to what was ordered. Not only for your horse, but for every time it was used.

Red Flag warning: Things get busy, and controlled substance logs aren’t always top of the priority list. If your vet fails to keep accurate records and the DEA stops by for a visit, your vet could face significant penalties.

Red Flag warning: Even with all these controls in place, your vet discovers that a bottle of ketamine has gone missing. Did it make it to the street? And if it did, could it have contributed to an overdose death?
While it may be annoying when your vet says “no” in response to a request for medication, it should be easy to understand why if that medication you requested is under DEA control. Your vet’s DEA license comes with both an enormous amount of responsibility to support efforts to protect the public from potentially dangerous medications, and potential liability if they don’t follow the rules.