Welcome to Spodek Law Group. Our goal is to give you the reality of DEA registration suspensions and revocations - not the sanitized version the government presents, not the procedural fiction that makes it sound fair, but the actual truth about what happens when the Drug Enforcement Administration decides your career is over before you ever get a hearing.
Here is something that should terrify every healthcare provider with a DEA registration: the agency that accuses you of wrongdoing is the same agency that decides your fate. The DEA Administrator - not an independent court, not a jury of your peers - makes the final call on whether you keep practicing medicine. And if they issue an "immediate suspension," your career is functionally destroyed before you ever get the chance to defend yourself.
Most practitioners believe that DEA proceedings work like court cases. You get charged, you get a hearing, you present evidence, and an impartial judge decides based on the facts. That is not how this works. The DEA has designed an administrative system where they can suspend your registration instantly under an "imminent danger to public health" standard so vague it could apply to almost anyone. You will sit in career limbo for twelve months or more waiting for your hearing while your practice collapses around you.
The 30-Day Trap That Destroys Careers
When the DEA issues an Order to Show Cause, you have exactly thirty days to respond. Thats it. Thirty days to find an attorney who understands DEA administrative law, gather your records, formulate a defense, and file a request for a hearing. Miss that deadline and your done. The DEA will issue a final order based entirely on its own allegations - deemed admitted because you didnt respond.
Heres what nobody tells you about this timeline. Most practitioners who recieve an Order to Show Cause are in shock. They cant beleive this is happening. They think there must be some mistake. They want to call the DEA and explain, maybe clear things up. That paralysis costs them everything.
In the Just Here II Pharmacy case from 2024, the DEA issued an Order to Show Cause and Immediate Suspension in October. The pharmacy didnt respond. Didnt request a hearing. Just... froze. By the time the final order came down in 2025, every allegation about failure to maintain accurate records was deemed admitted. No evidence required from the DEA. No defense considered. Career over becuase of silence.
The DEA is counting on this. They know that fear and confusion will cause some practitioners to default. Its the easiest revocation they'll ever get.
The Five-Factor Test: How One Mistake Ends Everything
The DEA evaluates whether your registration is "inconsistent with the public interest" using five factors laid out in 21 USC 823. Heres the part nobody emphasizes: these factors are considered in the disjunctive.
That legal term means any single factor can justify revocation. Not all five. Not a majority. Just one.
The five factors are:
- Failure to maintain effective controls against diversion
- Failure to comply with applicable state and local laws
- Prior federal or state convictions relating to controlled substances
- Lack of experience in distributing controlled substances
- Other factors relevant to public health and safety
See that fifth factor? "Other factors relevant to public health and safety" - thats a catch-all that gives the DEA almost unlimited discretion. And remember, ANY ONE of these is enough.
Heres the kicker. You might have impeccable controls against diversion. Zero convictions. Thirty years of experience. But if the DEA finds you failed to comply with some state regulation you didnt even know applied to you - one factor, just one - they can revoke your registration.
The system isnt designed to evaluate wheather your a good practitioner. Its designed to give the agency maximum flexibility to take registrations whenever they want.
When the DEA Is Prosecutor, Judge, and Executioner
In a normal court case, theres separation between the prosecutor who brings charges and the judge who decides guilt. Thats basic due process. Thats what keeps the system honest.
DEA registration proceedings dont work that way.
The DEA investigates you. The DEA files the Order to Show Cause. The DEA prosecutes the case at the administrative hearing. And then - heres were it gets truly absurd - the DEA Administrator makes the final decision on wheather to revoke your registration.
Yes, theres an Administrative Law Judge who hears the evidence and makes a reccomendation. But the DEA Administrator can reject, modify, or accept that recommendation. The ALJ's ruling isnt binding.
Think about what that means. You could win at your hearing. The ALJ could look at the evidence, hear your defense, and conclude that revocation isnt warranted. Doesnt matter. The DEA Administrator - an employee of the same agency that accused you - can overrule that decision and revoke anyway.
This is not a court proceeding. This is an administrative process designed for enforcement efficiency, not fairness.
At Spodek Law Group, we've seen this dynamic play out too many times. Practitioners go into their hearings thinking justice will prevail, not realizing the deck is already stacked. The agency that wants your registration has the final word on wheather you keep it.
The Voluntary Surrender Trap
When the DEA contacts you about an investigation, one of the first things there investigators might suggest is that you voluntarily surrender your registration. They'll make it sound reasonable. Avoid the hassle of proceedings. Spare yourself the public embarrasment. Just sign this form and walk away.
Do not do this.
Heres the irony nobody explains. If you voluntarily surrender your registration, you waive your right to an administrative hearing. You waive your right to present evidence. You waive your right to challenge the DEA's allegations. And when you try to reapply for a registration later - becuase maybe you want to practice medicine again someday - that voluntary surrender will be used against you.
The DEA will argue that your surrender was an admission that you couldnt defend yourself. That you knew the allegations were true. That giving you a new registration would be inconsistent with the public interest becuase you already admitted you werent fit to have one.
Sound familiar? The same agency that pressured you to surrender uses that surrender as proof you dont deserve to practice. Its a trap designed to make the DEA's job easier while permanantly destroying your career.
Todd Spodek has seen this tactic used against practitioners who thought they were making a pragmatic decision. They werent. They were signing away there futures.
The Prescribing Pattern Trap
Heres something that catches practitioners completly off guard. The DEA dosent just look at whether you followed the rules. They reconstruct your prescribing history and evaluate wheather each prescription served a "legitimate medical purpose."
Who decides what counts as legitimate? The DEA does. After the fact. Looking backwards at decisions you made in the moment with incomplete information about patients who may have been lying to you.
Consider how this actualy plays out. You see a patient presenting with pain. They have imaging studies, medical records, a coherent history. You prescribe an opioid. Maybe hydrocodone, maybe something stronger depending on the clinical picture. The patient fills the prescription and leaves.
What you dont know is that this patient is already filling prescriptions from three other doctors. Or that they're driving two hours to see you specificaly because practitioners closer to home have already flagged them. Or that the DEA is already watching this patient as part of a larger investigation.
Now that prescription - the one you wrote in good faith based on the information you had - becomes evidence of your failure to maintain effective controls against diversion. Factor one of five. One factor is enough.
But wait, it gets worse. The more documentation you have, the more material the DEA has to scrutinize. Did you document the physical exam completly? Did you check the prescription monitoring database before every single prescription? Did you document why you chose this drug at this dose? Did your documentation match exactly what you told the patient?
Practitioners who document thoroughy create longer paper trails for investigators to parse. Those who dont document get cited for inadequate records. Its a documentation paradox with no right answer - just different ways to be wrong.
And heres the uncomfortable truth practitioners need to hear. The DEA has access to your states prescription monitoring program data. They can see every controlled substance prescription you've written. Every patient. Every dose. Every refill. They can run algorithms that flag "outliers" - practitioners who prescribe more then there peers, or certain drugs more frequently, or in certain patterns.
You might be an outlier becuase you serve a different patient population. Chronic pain clinic? Higher prescribing is expected. Oncology? Same story. But the algorithm dosent know context. It just flags numbers. And those flags generate investigations.
The State Board Connection You Cant Escape
Many practitioners dont realize that DEA registration and state medical licensing are connected in ways that make defense exponentialy more difficult.
When the DEA takes action against your registration, your state medical board gets notified. This isnt optional. Its built into the system. The National Practitioner Data Bank recieves reports of adverse actions, and state boards have access to that information.
But heres were it gets truly problematic. Most state medical practice acts include grounds for discipline that track the DEA's five-factor test. If the DEA finds you failed to maintain effective controls against diversion, your state board can use that same finding - sometimes even the same evidence - to suspend or revoke your state medical license.
And it flows the other way too. Under 21 USC 824(a), the DEA can revoke your registration if your state license has been suspended, revoked, or denied. So if the state board acts first, the DEA can use that as an independent ground for revocation - even if the state action was based on allegations the DEA fed to the state in the first place.
Notice the pattern? Information flows in a circle. The DEA investigates you. Shares information with the state board. The state board takes action. The DEA uses that action as additional grounds for revocation. Each proceeding strengthens the other.
This creates a defense nightmare. Your fighting on two fronts simultaneusly, and the agencies are essentialy collaborating against you. Worse, anything you say in one proceeding can be used against you in the other. Any admission, any explanation, any statement made under the pressure of trying to keep your license becomes evidence in the parallel proceeding.
At Spodek Law Group, coordinating defense across federal DEA proceedings and state board investigations is something we take extremly seriously. You cannot treat these as separate problems. They are the same problem manifesting in two venues, and the strategy must account for both.
The Domino Effect: How One Registration Destroys Everything
Your DEA registration dosent exist in isolation. Its connected to every other aspect of your professional life. When it falls, everything falls with it.
Heres the cascade that nobody prepares you for:
Your DEA registration is suspended. Within days, your hospital is notified. There privileges committee meets - and suspends your privileges becuase you cant prescribe controlled substances. Now your on the hooks for explaining this to your malpractice carrier. They may drop you or refuse to renew.
Your on insurance panels? Those contracts have clauses requiring you to maintain all necesary licenses and registrations. DEA suspension triggers automatic termination from panels. Now your patients cant use there insurance to see you.
Staff? You cant pay them if your practice has collapsed. Layoffs. Your office lease? Still owed, but no income to pay it.
And heres the part thats truly devastating. This all happens while your case is pending. Remember, immediate suspension means your career is destroyed BEFORE the hearing. Even if you eventualy win - even if the ALJ rules in your favor - the damage is already done. Your practice is gone. Your staff found other jobs. Your patients moved on. Your savings are depleted from fighting the case.
The DEA dosent just revoke registrations. They detonate careers.
And theres one more domino. Your state medical board recieves notification of DEA action. Many states treat DEA revocation as grounds for state license suspension or revocation. Now your fighting on two fronts simultaneusly - and the state board will use the federal proceedings against you.
The Federal Register: Public Shaming Before Verdict
Theres one more aspect of this system that practitioners dont anticipate until it hits them: publicity.
When the DEA issues an Order to Show Cause, it gets published in the Federal Register. This isnt some obscure government database that nobody reads. Its searchable. Its indexed by Google. And it stays there permanantly.
What does this mean in practice? It means that before you've had any hearing, before any Administrative Law Judge has evaluated the evidence, before you've had any opportunity to present your defense - your name is associated with DEA enforcement action in a public, permanent, searchable record.
Patients Google you. Hospital credentialing committees Google you. Insurance panels Google you. Potential employers Google you. And what they find is a Federal Register notice alleging that you pose an "imminent danger to public health or safety" or that your registration is "inconsistent with the public interest."
Try explaining that in a job interview. Try explaining it to a hospital credentials committee. Even if you eventualy win your case - even if the ALJ finds in your favor and the DEA Administrator accepts that reccomendation - the original Order to Show Cause is still out there. The public record of the accusation never disappears.
This is reputational damage by administrative action. Your named in an official government document alleging serious misconduct before youve had any chance to respond. The presumption of innocence that applies in criminal court has no equivalent here. Your guilty in the court of Google search results from the moment the Order to Show Cause is published.
And heres the truly cynical part. This publicity pressure is part of the system design. Some practitioners see the Federal Register publication and decide to settle rather then fight - even if they have strong defenses - becuase the reputational damage is already done and they want to stop the bleeding. The DEA benefits from this dynamic. Every settlement is a case they dont have to litigate.
What You Must Do in the First 48 Hours
If you've recieved an Order to Show Cause, a letter of investigation, or any communication suggesting the DEA is looking at your registration, the clock is already running. You have days to act, not weeks.
First forty-eight hours matter more then anything that comes after. Heres what practitioners facing this situation need to understand:
Do not contact the DEA to "explain." Everything you say can and will be used in the administrative proceeding. Your natural instinct to clear things up will create a record of statements that investigators will parse for inconsistancies.
Do not voluntarily surrender. No matter what there investigators suggest about making things easier. That surrender eliminates your hearing rights and becomes permanant evidence of unfitness.
Do not ignore the Order to Show Cause. The thirty-day deadline is absolute. Missing it means automatic revocation based entirely on the DEA's allegations.
Do not assume this will work out. The system is not designed for fairness. The agency accusing you is the same agency that will judge you. Immediate suspension means career destruction before any hearing.
What you must do is get representation from attorneys who actualy understand DEA administrative law. Not your regular healthcare attorney. Not your malpractice defense firm. Someone who has been through these proceedings and understands how the five-factor test, the immediate suspension power, and the DEA Administrator's final authority actualy work in practice.
At Spodek Law Group, we dont give practitioners false hope. We give them the reality - and then we fight like hell within a system designed to destroy them. Thats the only honest approach when the deck is stacked this severely.
The DEA has been preparing there case for months or years before you ever heard about it. They have your prescribing records, your DEA 222 forms, your state prescription monitoring data. They've interviewed pharmacists and patients. They've built there file.
You have thirty days. Maybe less if immediate suspension is already in effect.
The next forty-eight hours determine wheather you fight from a position of strength or scramble to catch up. The question isnt wheather this situation is unfair - it is. The question is what your going to do about it.
Call us at 212-300-5196. The conversation is confidential. And unlike the DEA, we're actualy on your side.
