Ambulance services across the state will need to come up with a different system to store narcotics and track medication usage by July 14.
Locally, MaineHealth will no longer be providing narcotics to emergency medical services, making individual emergency medical services directly responsible for controlled substance compliance, documentation, and chain-of-custody tracking.
The changes come after the Drug Enforcement Administration implemented the Protecting Patient Access to Emergency Medications Act in February. According to the American Ambulance Association’s website, controlled substances were usually handled under the DEA registration of a hospital, pharmacy, or medical director. This new rule changes require EMS agencies to register to be formally recognized as DEA registrants.
To become compliant with the DEA, the Protecting Patient Access to Emergency Medications Act includes receipt and acquisition of controlled substances, storage, and inventory tracking; transfers between locations or vehicles; administration to patients; partial waste and destruction; and inventory reconciliation and auditing.
Central Lincoln County Ambulance Service Chief Nick Bryant said the service had been preparing for the implementation but didn’t know when it would need to happen until he received an email last week.
“This is probably one of the biggest operational changes for EMS in Maine in quite awhile,” Bryant said.
By July 14, Bryant said emergency services agencies that had used MaineHealth for controlled substance access will need to not only find their own distributors for medications but also will need to change the way medications are stored. The July deadline is for scheduled drugs, such as ketamine and fentanyl. By Oct. 1, MaineHealth will no longer distribute nonscheduled drugs, such as aspirin.
Bryant said the upfront costs for safes to keep the narcotics safe and secure for the station and trucks are around $40,000. There will also be changes in the way staff track and manage these substances, making sure everything is used and disposed of properly.
“We actually made the decision in March to move forward with the purchasing of the items to start to make us compliant, because we didn’t know if it was going to happen this summer,” Bryant said. “I mean, it could have been 12 months out, 18 months out, but it was very clear to me, at least something like this was going to happen with the direction it has headed.”
Waldoboro EMS Service Chief Derek Booker said since March, his station had been in “prepping mode,” gently rolling out new policies and procedures, reviewing their current ones, and learning about the new rules and practitioners manual from the DEA.
Because many staff members from Waldoboro and CLC ambulance work for both, Booker and Bryant said they were working on uniformity in how they approach these changes.
“We all tackle these things with a unified front, and it helps us work through it smoothly with everybody,” Booker said. “We just work very closely together, we always have and we will continue to do so.”
With the changes, Booker said the different emergency medical services have to submit an application through the diversion branch of the DEA. He said the new rules are primarily for diversion, such as avoiding the loss of medication.
Booker said the application asks generic questions about the station, such as who will be in charge of the medications and who employees should go to for questions. The DEA then schedules follow-up interviews and potential site visits.
He said the following questions are also about responsibility of signing for medications, deliveries, and disposal, and how the services plan on complying.
“It’s going to be a real change in our operations,” Booker said.
Once Waldoboro gets through the initial “hurdles” of the registration process and changes to buildings with the addition of new storage spaces, Booker said there will be changes in how the services approaches care, likely meaning more training for both him and his staff.
Since this process began, Booker said the DEA has been very responsive and easy to work with.
“It will not affect our ability to provide the high level of care that our community has come to expect, and it may even make it a little better in terms of how we are able to more safely and securely store those medications,” Booker said. “But again, there will certainly be a learning curve, and it’ll take us some time to make sure everybody is squared away in those regards.”
The Boothbay Region Ambulance Service is also dealing with these changes, Service Chief Kristen Roberts said. With MaineHealth no longer managing narcotics, the service will be facing major operational changes as it independently manages securing the storage of medications.
The initial costs will be a little bit less than other services because the Boothbay Region Ambulance Service’s storage is already DEA compliant on the ambulances, which Roberts said gives the service a “good starting point.”
The next steps, Roberts said, will include expanding the system already in place and purchasing additional secure storage. The additional storage will include electronic tracking capabilities, so the service can meet the new requirements.
“It actually kind of puts us potentially in a better spot financially than maybe some other services,” Roberts said. “The cost is significant, but where we already have a system in place, we’re just building off of that.”
Roberts said with everything factored in, the service is looking at spending $15,000 to $20,000 on these changes. This will be for the secured safes, software, tech support, and other smaller components.
As the July deadline nears, Roberts said the service will also be focusing on purchasing controlled substances and maintaining its own medication supply. Roberts said this is not something services have had to purchase in the past, so she has been doing research on how to do so properly.
“Everybody just has been eating, sleeping, and trying to figure out the best way to make this work for their own services and for their own communities that they serve,” Roberts said.
