PICTURE THIS: It's a busy Wednesday at work. Patients fill the waiting room. Phones ringing. Staff running around doing their jobs. The usual office activity. You go to the narcotic storage cabinet to pull out what you need for a surgery, but there’s nothing there. You check the logbooks – there should be five vials. Wait - that bottle of tablets you’ve been meaning to get rid of is gone too. 

Welcome to the stressful world of controlled substance thefts and losses. At TITAN, we’ve seen a tremendous number of mistakes made by clients when it comes to thefts and losses, whether at a solo practices or large clinics and hospitals.

What can you learn from their mistakes?

Security - Long before anything goes missing you should have invested in proper security systems (e.g., video surveillance, strong cabinets) to reduce the chances for diversion to occur. Similarly, you should have policies and procedures written and taught to staff about what to do in the event of a theft or significant loss of drugs. 

“Significant Loss” – A "significant loss" typically refers to any instance where there is a substantial discrepancy or unexplained disappearance of controlled substances that cannot be accounted for through documented transactions (such as dispensing to patients, returns, or waste disposal). Here’s the catch:  have you decided what’s “significant” for your practice? Is one pill missing significant? Two vials? An entire box of vials? What you decide directly impacts how often you will be reporting to DEA.

Notifying DEA About a Theft or Significant Loss:

You have two basic responsibilities if you discover a theft or significant loss of controlled substances:

  1. Report it to your local DEA office within ONE business day. It can be by email, fax, or some other documented form - and keep a copy as part of your official recordkeeping. Federal regulations do not require reporting to state or local law enforcement (it is a good idea, however, to do it), but your state’s rules may require it. 
  2. Within 45 days of filing the initial report, go online to the DEA Diversion website (www.deadiversion.usdoj.gov) and fill out DEA Form 106 with as much detail as you can. Keep a copy of the submitted form for your files. Also, you CANNOT submit the DEA Form 106 as the initial notification.

But here’s the twist:  Did you submit the initial notification within the 24-hour requirement, look into the loss? Did you find the supposedly missing drugs before you filed the DEA Form 106? Congratulations! You DO NOT have to file the DEA Form 106!  (A smart move:  To be as complete and accurate as possible, send some type of written communication to your local DEA office explaining how the initial notification was eventually resolved. Put it all in your files in case of a future inspection.)

TITAN TIP:  A big mistake we see a lot – filing a DEA Form 106 as a means of “balancing the books” when there are discrepancies in controlled substance counts or as the result of a controlled substance audit. If you have unresolved discrepancies and you’re thinking of doing this, call TITAN. We may have other options for you. 

So, what happens to your submitted information? The information from all 106s flows into a database searchable by any DEA agent or investigator. They can run reports to look for patterns, to see how you compare with competitors, to look for trends in activity, or simply to see who has filed the most reports. Depending on what they find, it could lead to an investigation.  And here’s something most registrants don’t know:  if the theft or loss is valued at $500 or more, the DEA is required – per Title 21 Code of Federal Regulations – to share the information with the FBI. That doesn’t mean the FBI is going to investigate your loss! But if you have large losses (whether in dollar value or quantities of controlled substances), recurring losses, or other indicators that there may be a bigger problem at your practice, you can expect DEA to knock on your door at some point. 

A few more TITAN TIPS to keep in mind about your thefts losses:

  • Documentation: Always maintain thorough records of controlled substance transactions, inventory audits, and security measures implemented.
  • Training: Conduct regular training sessions for staff on security protocols, recognizing suspicious activities, and completing the DEA Form 106 accurately.
  • Compliance Checks: Perform periodic compliance audits to assess adherence to DEA regulations and identify areas for improvement.

If you’ve filed a number of theft and loss notifications or 106’s over the last two years (let’s say three or more), contact TITAN to discuss an assessment of your practice. You may have an underlying process problem - or person - that needs to be investigated and addressed as soon as possible. Has the DEA already come around with questions about your losses? Then definitely call TITAN at (347) 723-8019 – we can provide vital support that could save you stress and money!