Help Needed-Controlled Substances Policies

Hi all-

I am curious about controlled substances policies in various states. Specifically:

Are paramedics in your state allowed to carry their controlled substances on their person while on duty? In other words, are the controlled substances considered secured when in the paramedic’s possession? Do you carry them in a pouch, for instance, during the course of your shift.

Or do they have to always be secured in a double locked container? And only allowed to carried by the paramedic when actually on a call with an intent to use them?

I have done some preliminary research and seen some variation in this.

I have seen states where “The requirement for securing of controlled substances may also be accomplished by having the approved certified and authorized personnel maintain direct possession of controlled substances while on duty.”

And I have seen states where carrying controlled substances on the paramedic’s person is prohibited unless there is an identified patient who needs the drugs.

I have also seen states where the locked controlled substances container is actually in the paramedic’s house bag.

I am curious what policies people are operating under out there.

Please comment below or else send me an email (see the Contact Me bar above).

My interest in this in helping shape policy that removes road blocks to pain management.

Please tell me about your system and its pros and cons.

Thanks so much,

Peter (medicscribe)

21 Comments

  • BadgerMedic says:

    Peter -

    I’m not sure about the actual wording per the state, but for our service we carry all of our narcotics in a clear Pelican case, with all the individual vials/ampules vaccum-wrapped in bags. The case is then locked in a double-locked cabinet in the Ambulance. This is a recent change from the old narcotic bags we used to have (both had/have numbered seals that need to be broken in order to open the bags.)

    The new Pelican cases however, allow the medics to visually see the dates/sizes of the medications without opening the overall package. This has been a good change in my opinion, due to the constantly changing sizes/packaging of the medications (vials to ampules to carpujets and different amounts.)

    The Pelican cases are great, but the size we use may not be suitable for your agency; we do not carry many narcotic/controlled substances or any RSI/induction agents on the regular Ambulances. We have supervisors and special bags that certain, RSI-cleared Medics check out on a daily basis from the main station. Our usual compliment of medications in the case is (approx) 16-20mg Morphine, 10mg Versed and 100-250mcg of Fentanyl.

    We are apparently going to be moving to biometric-style narcotic safes, activated by a new ID badge (which will eventually open station doors, etc.), and that logs who/when/how many times the safe was opened.

    I usually (depending on the short report) will just take the Pelican case and clip it to my belt (another benefit of it’s minute size) throughout the call.

    I hope this helps answer your question.

  • Peter says:

    Thanks, Badger. My question for you is do you have to return the kit to the safe immediately after every call? Or can you carry it on you throughout your shift?

  • Ncaroon says:

    We had some MD’s that ran EMS and they had their own “sweet box” they carried. As for other paramedic’s we had to keep them in a locked box seperate from the rest of the drugs. We had to check tags every shift and log them. If we used the drug we had to write down the lot #, Exp date, and write down our name. After we replaced it we logged the new drug and new tag. We also had to waste the drug when we got to the hospital with a nurse or another medic. I think it is risky carrying it on your person. If something happens to it, you are responsible for it. I personally wouldn’t want to take the responsiblity, it is your license and career.

    • medicscribe says:

      Thanks for the info. I am trying to find the best method to have the meds easily available to give while still meeting the security demands of the DEA/state Drug Control.

  • Mark F says:

    Drug boxes or bags holding authorized controlled substances must be double locked at all times using a two different key lock system, when not being used for patient care purposes. This means that the container holding the controlled substances must be locked and stored inside a key locked compartment within the ambulance, EASV or ALS first response vehicle in accordance with the approved agency controlled substance plan.

    • medicscribe says:

      Thanks Mark. That is consistent with the policy in our state. However, there are other states that permit medics to carry it on their person throughout the shift. I am trying to gauge how many states allow this and get documentation of it. I worked for a time in another state where we carried the narcs on us throughout the shift in a special pouch, which was very convenient. I am curious as to why the different rules. Is the federal law clear cut or are the federal laws open to different interpretation by different states and or their directors.

  • Medic Wicket says:

    I work in NY, which allows medics to carry on their person. The agencies I have worked for have at least one medic, if not both, carry the narcotics in a sealed clear bag or container that is then crried in a belt pouch. At tour change, a hand off log is signed by both the off going and oncoming paramdic(s). In the event that there is no relief, for hospital based services we secure the kits in either the pharmacy, or the ED pixis system. IN station based systems, either another crew would secure your narcs in a lock box at the station, where spare narcs would also be secured for restock, or each medic would have 1 key and the second key would remain in the station. In these situations, the medic would do a count of each time the lock box was opened and sign their kit in or out.
    Here is the link for NY’s laws for EMS. http://www.health.ny.gov/professionals/ems/part80.htm

  • John says:

    In our county, we carry a pelican case with all the meds. Many of the basics-epi, atropine, bicarb, D-50, narcan-are in boxed, prefilled syringes loose in the box. Anything in a bottle, vial, carpuject, or ampule (from aspirin to nitro to fetanyl, morphine, valium, versed) is kept in a zippered bag within the pelican case. If you only give a portion of a narc you have opened or drawn up, you have to have an RN or MD in the ER witness the wastage of it. Used boxes are exchanged in the ER or at the hospital pharmacy, depending on the hospital.

    The case has to be locked in the rig when not being used on a call. Ours have bicycle cables through the handles, it would not prevent someone from opening the box while in the rig and taking what they want. Boxes on the bags are sealed with a numbered tag, if a tag is broken the box has to be exchanged.

  • fakingpatience says:

    For the 3 different agencies I have worked at a medic for (in 2 different states) we handled the narcs 3 different ways. At agency 1 the narcs were in a locked (with a key) box, which was then locked inside a cabinet of the ambulance. Narc were checked and signed in in the morning and out at night, along with any usage.
    At agency 2 we carried the narcs in an unlocked box on our person. Again they were signed in and checked at the beginning of shift, and signed out and any usage marked at the end of the shift. When the narcs were not being held by a medic they were locked in a key lock box, which was then lock in a pass code safe (different code for each medic), which was in the key locked supply room. If we didn’t want to carry them in our pocket we could place the narc container in the larger locked box and place it in the fly car, but this was cumbersome to get out for every transport
    At agency 3 the narcs are kept in the locked fridge on the ambulance. Fridge is locked with a 3 digit lock, everyone uses the same code. The narcs are in a container which is “sealed” with one of the numbered pull tie things. At the beginning of the shift you would check that the seal is the same one that was signed out on the narc log the day before, and sign for them. You did not remove the seal unless you wanted to use the narcs. You didn’t need to sign anything at the end of the shift, but you did mark usage or restock and placement of a new seal.

    • medicscribe says:

      Thanks for the comments, faking patience. What state were you working in where they let you carry the controlled substance on your person?

  • BadgerMedic says:

    Sorry, got a little busy… No you are required to return it either when you decide not to utilize it or as soon as you reach the ED/finish the call.

  • Firemedic24 says:

    It is easier to launch a nuke than it is to give simple pain meds in the state of south carolina.

    Drugs stay locked on board until orders are given by the MD. We still require OLMC orders to give it… worst pain control policies in the country.

    • medicscribe says:

      Hi Firemedic, Sorry to hear about your policies down there. It’s a shame, those roadblocks to pain management still exist.

  • Jessica says:

    I work in North Carolina, we have to have two locks on our controlled substances. We have a “tool box” thats locks then again we lock the cabinet that we keep the “tool box” in. We have to sign the drug when coming onto a shift and again going off with the other crew member that gets to carry the drug keys. We do not need orders to give medications. I am currently wanting to give pain meds intranasal and if you have any research that would help me do so it would be great. I work in a community where most are over the age 65 and have many falls resulting in hip fx and i believe this would help with pain management before we even begin to move the pt. Thank you for touching on the topic of c-spine. My service has protocols that pretty much say if their greated than age 60 they have to be on a board, which is everyone, ha! I hate placing the pt with a hip fx from a fall from a standing position with massive kyphosis knowing im doing harm!!

    • medicscribe says:

      Hi Jessica- Thanks for the comments. I will email you some material on intranasal fentanyl. I am a big fan of it, Peter

  • Bobball says:

    We (Hennepin EMS in Minneapolis, MN) carry them on our person. If controlled drugs are used, they are replenished at HQ, with both medics signing (one for giving, one for witnessing the waste).

    Corrective action for failure to sign out replacement drugs, not replacing drugs, or not returning drug pouches to the locked cabinet system at the end of shift are pretty draconian; but have been so for the 25+ years I’ve been here, and they are clear and fair.

    Since we’re hospital-based (a department of Hennepin County Medical Center), our practices have not only been reviewed repeatedly by the state EMS Regulatory Board, but also by the Joint Commission, with no worries.

  • Peregrine005 says:

    At my part time job at a large hospital based EMS service, we carry our narcs in our pockets or on a pouch on our belts. In the city 911 division, the meds sealed in a plastic pouch with a usage form. Pelican cases are available. After usage, the usage form is filled out, as well as the ACR (the waste is documented and signed by an RN, PA, or MD on the electronic ePCR.) After usage our communications center is notified. City telemetry is also informed (they require the patients MRN from the hospital.) City telemetry also provides us a tracking number for documentation. After usage the pack is deposited in a safe.

    In our main division, narcs are secured in a hard plastic case (email me for pictures) with a peal on seal number. The documentation is the same. After usage, the pack is deposited in a locker at the end of tour, or swapped out with a patrol boss.

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