The biggest item this week: DEA revoked an Indiana nurse practitioner who prescribed opioids and stimulants by telehealth to patients she had never examined in person, and who gave ketamine and esketamine above recommended amounts without documenting why. Indiana law requires an in-person exam before an opioid can be prescribed by telehealth. If your clinic prescribes controlled substances remotely or runs a ketamine program, read item 1 first.
Covers October 9 to 15, 2026. Every item links to the agency document it comes from.
1. DEA revokes an Indiana nurse practitioner over telehealth prescribing and ketamine dosing
On October 14, 2026, DEA published an order revoking the registration of an Indiana nurse practitioner (FR Doc. 2026-20937), effective November 13, 2026. She defaulted, so the allegations were deemed admitted. From June 2024 to May 2025 she prescribed controlled substances to six patients, including opioids, stimulants, benzodiazepines and sleep medications in combination, and she administered ketamine and esketamine “in excess of the recommended amounts without documented medical analysis.”
DEA relied on 21 CFR 1306.04(a) and three Indiana rules. Ind. Code § 25-1-9.5-7 requires a prescriber using telehealth to establish a provider-patient relationship, including a medical history and the information needed for a diagnosis. Ind. Code § 25-1-9.5-8 bars prescribing an opioid by telehealth when the prescriber has not examined the patient in person. 848 Ind. Admin. Code 5-4-7 requires a check of INSPECT, the state prescription monitoring program, before prescribing an opioid. Her state license had also expired.
What to do: if your clinic prescribes controlled substances by telehealth, map each drug against your state’s in-person and monitoring program rules, and document a dose rationale for every ketamine or esketamine session. Telehealth ketamine clinic structure.
Source: Federal Register 2026-20937
2. A Montana APRN loses her registration over phentermine in a stimulant and sedative combination
On October 9, 2026, DEA published an order revoking the registration of a Montana advanced practice registered nurse (FR Doc. 2026-20751), effective November 9, 2026, also by default. From June 2022 to January 2025 she issued at least 109 controlled substance prescriptions to one patient, including alprazolam, lisdexamfetamine, hydrocodone-acetaminophen, phentermine and tramadol. DEA’s expert found the combination of a stimulant, a sedative and a narcotic put the patient at risk of dependence, overdose and fatal drug poisoning.
DEA cited missing physical exams, no objective diagnosis supporting long-term use, no urine drug screens, and a controlled medication agreement signed only a year after the prescribing began. The order relies on 21 CFR 1306.04(a) and Mont. Admin. R. 24.159.1204(1)(a), 24.159.1464(1) and (4), and 24.159.2301(2).
What to do: phentermine is Schedule IV. Before your weight-management program starts it, check the patient’s state prescription monitoring report for stimulants, opioids and benzodiazepines, and chart what you found. Weight management programs.
Source: Federal Register 2026-20751
3. A Hawaii pharmacy moved without updating its registration, and DEA revoked it
On October 9, 2026, DEA published an order revoking the registration of a Kahului, Hawaii clinic pharmacy (FR Doc. 2026-20750), effective November 9, 2026. In March 2023 the pharmacy moved to a new address without notifying the Hawaii Pharmacy Board or the state Narcotics Enforcement Board. It then dispensed about 300 controlled substance prescriptions, including Schedule II opioids, from the unregistered location. An audit covering May 2023 to July 2024 found 4,779 dosage units unaccounted for.
DEA relied on 21 CFR 1301.11(a) and 1301.12(a), which require a separate registration for each place where controlled substances are dispensed, and on the inventory and recordkeeping rules at 21 CFR 1304.04(a), 1304.11 and 1304.21(a).
What to do: if you relocate a clinic or open a second site that stocks testosterone, ketamine or any other controlled substance, the DEA registration and the state permit must name that address before the first dose leaves the cabinet. DEA registration by location.
Source: Federal Register 2026-20750
4. DEA moves to put concentrated 7-OH kratom products in Schedule I
On October 14, 2026, DEA published a notice of intent to temporarily place 7-hydroxymitragynine (7-OH) and mitragynine pseudoindoxyl in Schedule I above a threshold recommended by HHS on October 8 (Docket DEA-1570, FR Doc. 2026-20943). A product would be covered if it contains more than 1 mg of either substance per gram of solid or per milliliter of liquid, or if its mitragynine content is less than 100 times its 7-OH content. The order may issue on or after November 13, 2026. DEA is withdrawing its July 2026 notice, which used a lower threshold.
DEA says these products are sold online, in gas stations and in smoke shops as tablets, shots, gummies and powders, and that 7-OH has opioid activity. DEA also says that neither HHS nor DEA has found the substances safe to use below the threshold.
What to do: if your gym or wellness clinic sells kratom or “7-OH” products at the front desk, take them off the shelf now. Ask about kratom at intake, as you would for any opioid. Gyms and fitness.
Source: Federal Register 2026-20943
5. FDA warns a contract testing lab over microbiology data
On October 13, 2026, FDA posted an October 6 warning letter to Eurofins SF Analytical Laboratories, Inc. (MARCS-CMS 736056), a contract lab that runs microbiological tests on drug components and products for its customers. FDA found that results were selectively recorded, plates too crowded to count were not reported, zero counts were not checked by a second analyst, and a cracked, dried-out plate was recorded as passing. FDA says the drug products the lab tested are adulterated, and it questions whether customers “received incomplete or potentially inaccurate microbiological data.”
What to do: a certificate of analysis is only as good as the lab behind it. Ask your compounding pharmacy or peptide supplier which lab tests their products, and check that lab’s FDA history before you rely on its numbers. 503A vs 503B sourcing.
Source: FDA warning letter 736056
What this means for you
Three of this week’s five items are DEA orders, and each one turns on a record the clinic should already have: an in-person exam, a monitoring program check, a registered address. Telehealth and protocols make a program scale. They do not satisfy a state rule that asks for an exam or a database check before the prescription. Pull your controlled substance list this week and write down, drug by drug, which state rules apply to remote prescribing and where each one is documented. If you cannot fill in that table, book a call and we will build it with you.
This is general information, not legal advice. Rules vary by state and change. Confirm your own facts with counsel.