DEA Registration Restored
The AZANA is excited to announce that the ability for CRNAs in the state of Arizona to obtain their Drug Enforcement Administration (DEA) individual registration has officially been restored. It has been an uphill battle over the past six years, and this a huge win for Arizona CRNAs. This was an even more momentous task in that once something like this is interpreted from existing statute, it is significantly more difficult to reverse.
So how was it done? The AZANA updated and clarified the law.
Memoirs of a DEA Number
Like many subjects on a federal level, the remedy isn’t always straightforward. Since the early 1940’s CRNAs have administered anesthesia in Arizona based on laws in the Nurse Practice Act (A.R.S. § 32-1661). In 1999, the Arizona State Board of Nursing (BON) adopted rules to formalize the prescription drug ordering process for CRNAs. These scope of practice rules would remain in place until 2012 at which point they were moved from rule to statute.
This move to statute was tasked following a routine audit in 2011 by the Arizona Auditor General who at the time questioned certain provisions of these rules, which included granting prescriptive authority to CRNAs to write prescriptions and for patients to have them filled at pharmacies. The difference between the use of the “prescribing” language and authority for medications to be administered preoperatively, postoperatively, or as part of a procedure by “ordering” CRNAs created confusion and needed clarification. To clarify the difference between the practice of a CRNA and other advanced practice nurses who write prescription, the final consensus language provided that CRNAs could “order medication” instead of have “prescriptive authority,” and made its way into statute with SB1362 in 2012.
Prescriptive authority and federal law can get convoluted and vary greatly from state to state. What may be good for one state may not be good for another. In DEA regulations, “the term prescription means an order for medication which is dispensed to or for an ultimate user but does not include an order for medication which is dispensed for immediate administration to the ultimate user.”1 This definition of prescription is part of the basis for the DEA interpreting federal law for CRNAs. The “traditional” practice of nurse anesthetists – ordering and directly administering controlled substances and other drugs preoperatively, intraoperatively, and postoperatively – does not constitute “prescribing” under federal law.
Because the DEA has not regarded traditional CRNA practice as "prescribing" under federal law, most nurse anesthetists have not had to individually register with the DEA. Also, the DEA’s interpretation of federal law does not necessarily mandate a similar conclusion under state law.2
Following SB1362, the DEA interpreted the new language to mean that CRNAs did not have prescriptive authority and sent letters to the twelve Arizona CRNAs that had active DEA numbers, asking them to surrender the number or have it formally revoked. This unintended revocation left Arizona as one of the few states where CRNAs were unable to obtain DEA individual registration and left the providers required to have them looking for out of state solutions. While small in number, Arizona CRNAs required DEA numbers at various practices such as Indian Health Service and Veterans Health Administration Hospitals.
Clarifying the Law
In the 2017 legislative session, the AZANA was able to pass SB1336, which (amongst other things) restored prescriptive authority language. Soon after SB1336 was passed, both the AZ State BON and the AZANA contacted the DEA again, requesting they resume issuing DEA numbers to CRNAs in Arizona.
In May of 2018, after a full year of pressure that included a letter from Senator Jeff Flake’s office, the DEA notified the AZ State BON that they would, in fact, begin issuing DEA numbers to CRNAs.
With the new passage of SB1336, the AZANA clarified that CRNAs have prescribing authority, but that it does not include the ability to write or issue a prescription for medications to be filled by a patient. This was not an expansion of scope, but essentially restored CRNA’s ability to obtain DEA numbers so that they are able to practice in settings where they are required, as was the case prior to the 2012 change.
This win was very much a team effort brought forth by the AZANA in conjunction with the AZ State BON. These efforts highlight the importance of maintaining these good working relationships. With remarkable persistence the AZANA was able to get difficult legislation passed without having to make unacceptable compromises (which is not always the case in many states with this type of legislative push).
A Huge Win for Arizona
Restoring prescriptive authority language that allows for DEA numbers has specific advantages that affect all Arizona CRNAs. First, it allows CRNAs to practice where individual DEA numbers are required. Other important advantages include greater autonomy and professional independence capacity (improved leadership qualification and ability to order necessary supplies, etc.), reduction of perceived surgeon liability fears (even though no liability was verified in statute with SB1336)3, helping resolve questions/issues related to cosignatures, and enhancing opportunities in pain management. Healthcare is continually shifting under our feet and opportunities for independent CRNA practice in Arizona continue to grow. With every increasing capacity and advantage putting CRNAs on a level playing field with other healthcare providers, the better we are all served.
How Do I Apply?
Most Arizona CRNAs do not need a DEA number and can legally practice under their facility's DEA number at this time. While you are fully able to apply for a DEA number at this time, we encourage you to only submit an application if needed for employment. We have secured this win and don’t need to inundate the DEA with CRNA applications. Online 224 forms are located at: https://apps.deadiversion.usdoj.gov/webforms/newAppLogin.do where you would select “MLP – Nurse Practitioner ($731 / 3 YRS).”4
Notable thanks goes to Senator Jeff Flake and his office staff, President Randy Quinn and all of the staff at the AZ State BON, as well as all the preceding and present AZANA Board of Directors and committee members for your persistence and hard work fighting to secure this win and restore DEA numbers for Arizona CRNAs. Also, thank you Arizona CRNAs for your continual AANA membership and PAC support that played an enormous role in facilitating this win. This continual membership backs the only association exclusively looking out for your profession, your AZANA.