The DEA made a surprise visit to my office yesterday. This apparently was prompted because a vendor reported a suspicious order – AN ORDER THEY DID NOT COMPLETE. I tried to order a vial of ketamine to do infusions for depression.  I did this because the psychiatric hospital that was doing them, 1.5 hours away, abruptly stopped their ketamine clinic when the physician who ran the program resigned. The patient found me because I received my REMS certification for Spravato – a new FDA approved drug, a nose spray, a derivative of ketamine that is very expensive ($4700/month).  He had had a fantastic response to ketamine, which was life altering for him, after 30 years of debilitating depression from bipolar disorder. He was now overdue for an infusion, and was spiraling down, becoming more depressed with suicidal ideation. He was being treated by a nurse practitioner who was only treating him with a single agent for his bipolar disorder, which I did not feel was adequate. I agreed to treat him and told him I wanted to take over all the treatment.  I ended up ordering the ketamine from a pharmacy that also gets Spravato, we simply had the patient pay for it ($14 which covers several infusions) and they sent it to the office. The patient has had a fantastic response to the infusions. I am using the protocol most sites have used – twice weekly for one month then monthly infusions at 0.5mg/kg infused over about 1 hour. We monitor vitals (BP, 02sat, pulse). We do have an AED, ambu bags, ACLS meds, EKG, and between my RN and me are ATLS, ACLS, PALS and NALS certified, though at such a low dose, ketamine thus far has shown to be quite safe. The side effects in the studies of both ketamine and esketamine have been hypertension, dissociation and sedation. We monitor patients for 2 hours. We also have one patient recently started on Spravato and we are following the REMS protocol for that patient, who is also responding quite well.

The DEA agents came in, told me that this vendor had alerted them that I ordered ketamine, which they found “suspicious”. I laughed because the patient was upstairs in our infusion room. The agent then went on to state that she then investigated further, saw my consent agreement with the state Board and had questions about my methadone prescribing. She had allegations that were false, so I corrected her. Many notes were taken. I told them which controlled substances are on site, how we account for them, how we document, what procedures we do, and everything else. I offered to show them our narcotics cabinet and documentation, the agents declined stating that would require paperwork. I am fully aware they could come back with that exact paperwork, so their declination does not mean all is over. For those wondering, I called my attorney who was on speaker phone through all of this. I will never speak to anyone without an attorney present and advise the same for all others. No agency is your ‘friend’ in medicine. No call is innocent. Do not speak, do not answer without an attorney. Take it from those of us who made that mistake.

What really shocks me is that the vendor did not bother to contact me. If they had concerns why was there no communication? Why have they not assigned a sales person to my office? What has happened to customer service? Clearly for physicians there is none. I understand the need to report, and that everyone is doing their job but had there been any sort of communication, all of this would have been avoided.

This follows the adage of no good deed goes unpunished. The patient has offered to testify on my behalf should that become necessary. He jokingly said to bill his insurance company for a higher rate – oh if only I could. Yes indeed this is another unfunded nuisance. It happened during office hours, meant no lunch for me, and yes indeed I went and drank at the end of the day – being the lightweight that I am 2 drinks was all I needed to rid myself of the angst from the DEA showing up at my office. Law school cannot start soon enough.