What Should I Do if the DEA is Investigating My Ketamine Prescription Practices?

The Call That Should Have Preceded This One

Retain counsel before you do anything else. Before you organize your files, before you telephone your compounding pharmacy, before you instruct your staff, before you compose a response to whatever communication initiated your concern, the first act is the retention of an attorney whose practice concentrates on federal controlled substance defense. Not a general practitioner of criminal law. Not the attorney who incorporated your clinic. A lawyer who has sat across the table from DEA Diversion Investigators and who understands that the agency’s interest in your ketamine prescribing, once formalized, operates on a timeline and according to an institutional logic that does not pause while you determine how to respond.

The physicians who contact this firm in the early phase of a DEA inquiry occupy a position the enforcement apparatus was not designed to dismantle. The physicians who contact this firm after speaking with agents, after surrendering records without counsel’s review, after attempting to demonstrate good faith through cooperation that the government will recharacterize as admission, occupy a position from which recovery is possible but from which options have contracted in ways that cannot be reversed.

This distinction is not theoretical. It is the difference we observe in outcomes.

Silence Is a Constitutional Right the Medical Profession Trains You to Abandon

Do not speak with DEA agents without your attorney present. We have addressed this principle at length in a prior article concerning office interviews, and the frequency with which physicians disregard it has not diminished. The instinct to cooperate is professional before it is personal. A physician who has spent a career responding to credentialing bodies, to insurance auditors, to state medical board inquiries, carries an institutional reflex toward disclosure that federal investigators recognize and, with considerable skill, exploit. In seven of the eleven ketamine-related matters this firm reviewed between January 2025 and the present month, the government’s case relied upon voluntary statements the practitioner offered, without counsel, during the initial encounter with Diversion Investigators.

Under Beckwith v. United States, agents are not required to provide Miranda warnings during noncustodial questioning. Under 18 U.S.C. Section 1001, any materially false statement you make to a federal agent constitutes a separate felony. Under Salinas v. Texas, your silence during a voluntary interview can be used against you at trial unless you invoke the Fifth Amendment in express terms. The corridor is narrow. Candor becomes evidence. Inaccuracy becomes a separate charge. Silence itself, unless invoked through formal constitutional language, becomes an inference.

Your attorney speaks for you, or no one speaks at all.

The Records You Preserve Determine the Defense You Possess

The moment you become aware of DEA interest in your practice, whether through a Form 82 inspection notice, an administrative subpoena, patient reports of agent contact, or the subtler indicators we have catalogued elsewhere, a document preservation obligation attaches that is both legal and strategic. You must preserve every patient record, every prescription log, every PDMP query, every communication with compounding pharmacies, every inventory reconciliation, every informed consent form, every piece of correspondence with distributors, and every internal communication among clinic staff concerning prescribing protocols, patient intake, or controlled substance management.

Preserve means preserve. Not organize, not consolidate, not improve. The physician who reviews patient charts after learning of an investigation and supplements the documentation to reflect clinical reasoning that was present in the encounter but absent from the record has committed an act that federal prosecutors will describe as obstruction. The chart that is incomplete is a compliance deficiency. The chart that has been amended after the investigation commences is evidence of consciousness of guilt, and the latter is orders of magnitude more destructive than the former.

The record that existed on the day the investigation began is the record upon which the defense will be constructed. What the record contains is a clinical question. What happens to the record after the investigation is known is a criminal one.

Instruct your staff, in writing, that no records are to be altered, deleted, moved, or destroyed. Instruct your electronic health record vendor to preserve access logs and audit trails. If your practice employs a shredding service on a scheduled rotation, suspend it. The preservation instruction should be documented and dated. Counsel will draft a formal litigation hold if the circumstances require one.

The Ketamine Compliance Review That Cannot Wait

Under the direction of your attorney, and within the protection of the attorney-client privilege, conduct an immediate review of your ketamine prescribing practices against the regulatory framework the DEA will apply. The review is not an exercise in self-improvement. It is a diagnostic instrument designed to identify the vulnerabilities the government has, in all probability, catalogued through PDMP data, ARCOS transaction records, and distributor suspicious order reports, and to determine whether those vulnerabilities are explicable within the framework of legitimate medical practice or whether they require remediation that your counsel can present as evidence of good faith before the government presents their absence as evidence of indifference.

The review must address whether every prescription was issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice, the standard articulated in 21 C.F.R. 1306.04(a) and refined by the Supreme Court in Ruan v. United States. It must examine whether individualized clinical rationale appears in the medical record for each patient, not a protocol applied without variation across the patient population, but documentation that reflects a mind that considered this patient’s history, this patient’s prior treatments, this patient’s specific clinical presentation, and arrived at a conclusion that the record makes legible. It must determine whether PDMP queries were conducted and documented at every encounter. It must verify that controlled substance logs account for every milligram of ketamine from acquisition through administration or dispensing.

As of February 2024, the civil penalty for each record-keeping violation stands at $18,759. For each prescription violation, $80,850. A clinic that has administered ketamine to three hundred patients over the course of a year and maintained deficient documentation for even a modest fraction of those encounters confronts potential liability that accumulates with the mechanical indifference of arithmetic. The DEA does not need to prove that a record-keeping deficiency was intentional. Negligence is sufficient for the agency to pursue revocation.

The Compounding Pharmacy Relationship Requires Examination

In the spring of 2026, the relationship between prescriber and compounding pharmacy has become one of the primary vectors through which DEA enforcement enters the ketamine prescribing space. The agency’s attention to compounding pharmacies that supply ketamine for home administration, particularly in lozenge and nasal spray formulations, has intensified since the FDA published compounding risk alerts in February 2022 and October 2023 identifying the potential dangers of unsupervised self-administration of compounded ketamine products.

Your counsel must examine the nature and documentation of your relationship with every compounding pharmacy that has filled your ketamine prescriptions. The examination should determine whether the pharmacy holds a valid DEA registration and state compounding license, whether the pharmacy’s dispensing records reconcile with your prescribing records, whether the pharmacy has been the subject of its own regulatory action or inspection (information that may not have been communicated to you but that the DEA possesses), and whether the volume of ketamine flowing through the prescriber-pharmacy relationship is consistent with the individualized clinical assessments your records are supposed to reflect. A compounding pharmacy that fills four hundred identical ketamine lozenge prescriptions from a single prescriber in a single quarter tells a story the agency has learned to read, and the story it tells is one of protocol-driven dispensing rather than individualized treatment.

Whether the agency’s reading of that pattern is always correct is a question that deserves more honest engagement than the enforcement posture permits at present.

The Telehealth Architecture That May Not Survive Examination

If your ketamine prescribing operates through a telehealth model, the compliance review must address a regulatory framework that is, at this writing, provisional. The DEA’s Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities, published December 31, 2025, permits DEA-registered practitioners to prescribe Schedule III controlled substances via audio-video encounters without a prior in-person evaluation through December 31, 2026. The permission is real. The word “temporary” has appeared in each of the four extensions, and the proposed permanent regulations, which will impose Special Registration requirements, enhanced record-keeping obligations, PDMP verification protocols, and specific reporting requirements for ketamine, tramadol, and benzodiazepines, remain pending.

The telehealth ketamine operation that was constructed during the pandemic era, that has treated hundreds of patients without a single in-person encounter, that has built its intake protocols and follow-up procedures on a regulatory permission the agency describes as transitional, must be evaluated against not only the current temporary framework but the permanent framework the agency has indicated it intends to impose. Your counsel should assess whether each telehealth encounter satisfies the existing requirements: that the encounter employed interactive audio-video technology (audio-only does not satisfy the standard for new patients), that the prescription was for a legitimate medical purpose within the usual course of professional practice, that all applicable state telemedicine requirements were satisfied, and that the documentation reflects a clinical encounter of sufficient substance to support the prescription issued.

A telehealth model that prescribes ketamine in fifteen-minute initial consultations, that employs identical dosing protocols across diagnostic categories, that generates prescription volume inconsistent with individualized assessment, will not survive the scrutiny the current enforcement climate applies. Whether the model was lawful when it was constructed is a separate question from whether it will withstand the examination the DEA now conducts.

The Parallel Proceedings You Must Anticipate

A DEA investigation of your ketamine prescribing practices does not remain a DEA investigation. The agency’s findings may be referred to the United States Attorney’s Office for criminal prosecution under 21 U.S.C. 841. They may be transmitted to the Department of Health and Human Services Office of Inspector General for exclusion proceedings that would bar you from participation in Medicare, Medicaid, and all federal healthcare programs. They may be shared with your state medical board under information-sharing agreements that exist between federal and state regulatory bodies. They may trigger audit activity from commercial insurance carriers whose Special Investigations Units monitor the same prescribing data the DEA examines through different institutional channels.

The physician who engages the DEA inquiry as a single-front proceeding will discover that the defense constructed for one forum may generate exposure in another. A statement made to DEA investigators in the hope of resolving an administrative matter can become a government exhibit in a criminal prosecution. A document produced in response to a state medical board inquiry can be subpoenaed by a federal grand jury. The coordination among these bodies has accelerated since the Department of Justice’s Health Care Fraud Data Fusion Center, announced in 2025, began aggregating data across the DEA, the FBI, the OIG, and CMS through analytics platforms designed to correlate prescribing patterns across regulatory silos that had operated in relative isolation.

Counsel who understands the ketamine enforcement environment manages all fronts at once, because the proceedings that appear separate are, in their evidentiary architecture, a single structure.

The Precedents That Instruct

The prosecution of Dr. Salvador Plasencia in connection with Matthew Perry’s fatal ketamine overdose in October 2023 produced a sentence of thirty months in federal prison on four counts of ketamine distribution. Dr. Mark Chavez, who diverted ketamine from his former clinic, received eight months of home detention. In January 2024, federal prosecutors in the Eastern District of Missouri charged Dr. Asim Ali and Dr. Mohd Malik with twenty-two felony counts, including conspiracy to distribute controlled substances and healthcare fraud, in connection with a ketamine clinic where one physician administered ketamine under another physician’s DEA registration at an unauthorized location. A periodontics clinic in Washington lost its DEA registration after the registrant permitted a dentist to prescribe controlled substances, including ketamine, under the registrant’s DEA number without oversight.

DEFENSE TEAM SPOTLIGHT

Todd Spodek

Lead Attorney & Founder

Featured on Netflix's "Inventing Anna," Todd Spodek brings decades of high-stakes criminal defense experience. His aggressive approach has secured dismissals and acquittals in cases others deemed unwinnable.

NY Bar Admitted Multi-State Licensed Federal Courts

Meet the Full Team

The pattern across these cases is not prescribing for an impermissible purpose. The pattern is operational: registration violations, documentation failures, delegation of controlled substance authority to unauthorized personnel, clinical structures that could not demonstrate, under examination, that the prescriber-patient relationship the Controlled Substances Act requires had existed in any form the statute recognizes. These are not cases about whether ketamine therapy is legitimate. They are cases about whether the documentation and operational infrastructure surrounding that therapy can survive the scrutiny the agency applies.

Most physicians who prescribe ketamine do so in good faith. Good faith, without the records that make it legible, is a disposition the government cannot perceive.

The Specific Acts That Must Occur in the First Seventy-Two Hours

The first act is the retention of counsel experienced in DEA defense and healthcare fraud. The second, conducted under counsel’s direction: issue a written document preservation instruction to all staff with access to patient records, prescribing logs, controlled substance inventories, or clinic communications. The third: compile a complete inventory of all ketamine in your possession, at every location authorized under your DEA registration, and reconcile that inventory against your ordering records and dispensing logs. The fourth: identify every compounding pharmacy that has filled your ketamine prescriptions in the preceding three years and gather the records of those transactions. The fifth, which most practitioners and most counsel neglect: secure your electronic communications, including text messages, encrypted messaging applications, emails, and any platform through which you have discussed prescribing practices, patient cases, or business operations with partners, staff, or compounding pharmacies, because the government’s evidentiary interest extends beyond the medical record into the communications that reveal the intent the medical record was constructed to demonstrate.

These five acts, completed within seventy-two hours and under the protection of the attorney-client privilege, establish the foundation upon which every subsequent decision rests.

The Scope of What Follows

The ketamine enforcement environment of March 2026 bears little resemblance to the environment that existed when the first telehealth ketamine clinics appeared during the pandemic. The DEA’s ARCOS IQ analytical platform has been reconfigured to detect ketamine prescribing patterns. The proposed permanent telemedicine regulations will impose obligations that much of the current telehealth infrastructure was not constructed to satisfy. The agency’s enforcement posture, shaped by the public visibility of the Perry prosecution and the St. Louis indictments, has consolidated around a position that treats documentation deficiencies in ketamine prescribing with the same institutional gravity it once reserved for opioid diversion.

The practitioner who prescribes ketamine in good faith, who maintains individualized clinical documentation, who conducts and records PDMP queries, who reconciles inventory, who prescribes within the scope of a genuine clinical relationship, occupies a position the enforcement apparatus was designed to leave undisturbed. The distance between that position and the one occupied by the practitioner whose documentation cannot demonstrate what the practitioner’s clinical judgment in fact accomplished is the distance counsel is retained to measure and, where possible, to close.

If the DEA has expressed interest in your ketamine prescribing, the consultation with this firm is the act that precedes every other act. The conversation is privileged. It is not a commitment. It is a determination of where you stand, conducted in the diminishing interval before the agency determines it for you. One calls because the enforcement climate has arrived at a place where the prescriber who waits for certainty has, in most of the cases we have observed, waited precisely long enough to forfeit the options that existed before the certainty materialized.