Proposed Aggregate Production Quotas for Schedule I and II Controlled Substances and Assessment of Annual Needs for the List I Chemicals Ephedrine, Pseudoephedrine, and Phenylpropanolamine for 2024, 75312-75323 [2023-24282]
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demonstrate that he has undertaken
corrective measures. Holiday CVS,
L.L.C., dba CVS Pharmacy Nos 219 and
5195, 77 FR 62316, 62339 (2012)
(internal quotations omitted). Trust is
necessarily a fact-dependent
determination based on individual
circumstances; therefore, the Agency
looks at factors such as the acceptance
of responsibility, the credibility of that
acceptance as it relates to the
probability of repeat violations or
behavior, the nature of the misconduct
that forms the basis for sanction, and the
Agency’s interest in deterring similar
acts. See, e.g., Robert Wayne Locklear,
M.D., 86 FR 33738, 33746 (2021).
When a respondent declines to testify
and ‘‘neither [takes] responsibility for
his misconduct nor provid[es] any
assurances that he has implemented
remedial measures to ensure such
conduct is not repeated,’’ the
respondent’s silence weighs against
registration. Zvi H. Perper, M.D., 77 FR
64131, 64142 (2012) (citing Medicine
Shoppe-Jonesborough, 73 FR 364, 387
(2008)); see also Jeanne E. Germeil,
M.D., 85 FR 73786, 73803 (2020). Such
silence also warrants an adverse
inference against the respondent.
MacKay v. Drug Enf’t Admin, 664 F.3d
808, 820 (10th Cir. 2011) (upholding the
Agency’s finding that a respondent’s
failure to testify warranted an adverse
inference because there was ‘‘no
evidence that [respondent] recognized
the extent of his misconduct and was
prepared to remedy his prescribing
practices’’); T.J. McNichol, M.D., 77 FR
57133, 57153–54 (2012) (stating that ‘‘it
is appropriate to draw an adverse
inference from Respondent’s failure to
testify’’).
Here, Respondent has failed to accept
responsibility or offer any basis for the
Agency to trust him, despite his past
misconduct, with the responsibility of a
registration. RD, at 21. In light of
Respondent’s silence, he has not
sufficiently demonstrated that he can be
entrusted with a DEA registration. See
id.; MacKay, 664 F.3d at 820; Jeanne E.
Germeil, M.D., 85 FR at 73803; Zvi H.
Perper, M.D., 77 FR at 64142.
In addition to acceptance of
responsibility, the Agency looks to the
egregiousness and extent of the
misconduct, Garrett Howard Smith,
M.D., 83 FR at 18910 (collecting cases),
and considers both specific and general
deterrence when determining an
appropriate sanction. Daniel A. Glick,
D.D.S., 80 FR 74800, 74810 (2015). Here,
Respondent’s blatant and repeated
disregard for the laws relating to
controlled substances warrants a
sanction. Respondent’s inappropriate
and unlawful prescribing of controlled
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substances placed multiple patients,
and the public, at risk of harm. In this
case, the Agency believes that denial of
Respondent’s application would deter
Respondent and the general registrant
community from disregarding
controlled substance laws and engaging
in the pattern of misconduct that
permeated Respondent’s actions as a
registrant. See RD, at 22. As the Chief
ALJ noted, ‘‘[t]he misconduct
established was sufficiently egregious
that a denial is strongly supported.’’ RD,
at 22. Further, there is no evidence that
Respondent’s behavior is unlikely to
recur in the future such that the Agency
can entrust him with a registration.
In sum, the public interest factors
weigh in favor of denial as a sanction;
accordingly, the Agency shall order the
sanctions the Government requested, as
contained in the Order below.
Order
Pursuant to 28 CFR 0.100(b) and the
authority vested in me by 21 U.S.C.
823(g)(1), I hereby deny the DEA
registration application of Osmin A.
Morales, M.D. (Control No.
W20125906C) and any other pending
application of Osmin A. Morales, M.D.,
for a DEA registration in Florida. This
Order is effective December 4, 2023.
Signing Authority
This document of the Drug
Enforcement Administration was signed
on October 25, 2023, by Administrator
Anne Milgram. That document with the
original signature and date is
maintained by DEA. For administrative
purposes only, and in compliance with
requirements of the Office of the Federal
Register, the undersigned DEA Federal
Register Liaison Officer has been
authorized to sign and submit the
document in electronic format for
publication, as an official document of
DEA. This administrative process in no
way alters the legal effect of this
document upon publication in the
Federal Register.
Heather Achbach,
Federal Register Liaison Officer, Drug
Enforcement Administration.
[FR Doc. 2023–24151 Filed 11–1–23; 8:45 am]
BILLING CODE 4410–09–P
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DEPARTMENT OF JUSTICE
Drug Enforcement Administration
[Docket No. DEA–1228P]
Proposed Aggregate Production
Quotas for Schedule I and II Controlled
Substances and Assessment of
Annual Needs for the List I Chemicals
Ephedrine, Pseudoephedrine, and
Phenylpropanolamine for 2024
Drug Enforcement
Administration, Department of Justice.
ACTION: Notice with request for
comments.
AGENCY:
The Drug Enforcement
Administration (DEA) proposes to
establish the 2024 aggregate production
quotas (APQ) for controlled substances
in schedules I and II of the Controlled
Substances Act (CSA) and the
assessment of annual needs (AAN) for
the list I chemicals ephedrine,
pseudoephedrine, and
phenylpropanolamine. For the 2024
quota year, DEA intends to allocate
procurement quotas to DEA-registered
manufacturers of schedule II controlled
substances on a quarterly basis. In order
to address domestic drug shortages of
controlled substances, procurement
quota allocations will be divided
between quantities authorized for
domestic sales and quantities
authorized for export sales.
DATES: Electronic comments must be
submitted, and written comments must
be postmarked, on or before December
4, 2023. Interested persons may file
written comments on this notice in
accordance with 21 CFR 1303.11(c) and
1315.11(d). Commenters should be
aware that the electronic Federal Docket
Management System will not accept
comments after 11:59 p.m. Eastern Time
on the last day of the comment period.
Based on comments received in
response to this notice, the
Administrator may hold a public
hearing on one or more issues raised. In
the event the Administrator decides in
her sole discretion to hold such a
hearing, the Administrator will publish
a notice of any such hearing in the
Federal Register. After consideration of
any comments or objections, or after a
hearing, if one is held, the
Administrator will publish in the
Federal Register a final order
establishing the 2024 aggregate
production quotas for schedule I and II
controlled substances, and an
assessment of annual needs for the list
I chemicals ephedrine,
pseudoephedrine, and
phenylpropanolamine.
SUMMARY:
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To ensure proper handling
of comments, please reference ‘‘Docket
No. DEA–1228P’’ on all correspondence,
including any attachments. DEA
encourages that all comments be
submitted electronically through the
Federal eRulemaking Portal, which
provides the ability to type short
comments directly into the comment
field on the web page or attach a file for
lengthier comments. Please go to https://
www.regulations.gov and follow the
online instructions at that site for
submitting comments. Upon completion
of your submission, you will receive a
Comment Tracking Number for your
comment. Please be aware that
submitted comments are not
instantaneously available for public
view on Regulations.gov. If you have
received a Comment Tracking Number,
your comment has been successfully
submitted, and there is no need to
resubmit the same comment. Paper
comments that duplicate electronic
submissions are not necessary and are
discouraged. Should you wish to mail a
paper comment in lieu of an electronic
comment, it should be sent via regular
or express mail to: Drug Enforcement
Administration, Attention: DEA Federal
Register Representative/DPW, 8701
Morrissette Drive, Springfield, Virginia
22152.
FOR FURTHER INFORMATION CONTACT:
Scott A. Brinks, Regulatory Drafting and
Policy Support Section, Diversion
Control Division, Drug Enforcement
Administration; Mailing Address: 8701
Morrissette Drive, Springfield, Virginia
22152, Telephone: (571) 776–3882.
SUPPLEMENTARY INFORMATION:
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ADDRESSES:
Posting of Public Comments
Please note that all comments
received in response to this docket are
considered part of the public record.
They will, unless reasonable cause is
given, be made available by the Drug
Enforcement Administration (DEA) for
public inspection online at https://
www.regulations.gov. Such information
includes personal identifying
information (such as your name,
address, etc.) voluntarily submitted by
the commenter.
The Freedom of Information Act
applies to all comments received. If you
want to submit personal identifying
information (such as your name,
address, etc.) as part of your comment,
but do not want it to be made publicly
available, you must include the phrase
‘‘PERSONAL IDENTIFYING
INFORMATION’’ in the first paragraph
of your comment. You must also place
all the personal identifying information
you do not want made publicly
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available in the first paragraph of your
comment and identify what information
you want redacted.
If you want to submit confidential
business information as part of your
comment, but do not want it to be made
publicly available, you must include the
phrase ‘‘CONFIDENTIAL BUSINESS
INFORMATION’’ in the first paragraph
of your comment. You must also
prominently identify confidential
business information to be redacted
within the comment.
Comments containing personal
identifying information or confidential
business information identified and
located as directed above will generally
be made available in redacted form. If a
comment contains so much confidential
business information or personal
identifying information that it cannot be
effectively redacted, all or part of that
comment may not be made publicly
available. Comments posted to https://
www.regulations.gov may include any
personal identifying information (such
as name, address, and phone number)
included in the text of your electronic
submission that is not identified as
directed above as confidential.
An electronic copy of this document
is available at https://
www.regulations.gov for easy reference.
Legal Authority
Section 306 of the Controlled
Substances Act (21 U.S.C. 826) requires
the Attorney General to establish
production quotas for each basic class of
controlled substances listed in
schedules I and II, and for the list I
chemicals ephedrine, pseudoephedrine,
and phenylpropanolamine. The
Attorney General has delegated this
function to the Administrator of DEA
pursuant to 28 CFR 0.100.
Analysis for Proposed 2024 Aggregate
Production Quotas and Assessment of
Annual Needs
The proposed 2024 aggregate
production quotas (APQ) and
assessment of annual needs (AAN)
represent those quantities of schedule I
and II controlled substances, and the list
I chemicals ephedrine,
pseudoephedrine, and
phenylpropanolamine, to be
manufactured in the United States (U.S.)
in 2024 to provide for the estimated
medical, scientific, research, and
industrial needs of the United States,
lawful export requirements, and the
establishment and maintenance of
reserve stocks. These quotas include
imports of ephedrine, pseudoephedrine,
and phenylpropanolamine, but do not
include imports of controlled
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substances for use in industrial
processes.
Aggregate Production Quotas
In determining the proposed 2024
APQ, the Administrator has taken into
account the criteria of 21 U.S.C. 826(a)
and 21 CFR 1303.11, including the
following seven factors:
(1) Total net disposal of the class by
all manufacturers during the current
and two preceding years;
(2) Trends in the national rate of net
disposal of the class;
(3) Total actual (or estimated)
inventories of the class and of all
substances manufactured from the class,
and trends in inventory accumulation;
(4) Projected demand for such class as
indicated by procurement quotas
requested pursuant to [21 CFR] 1303.12;
(5) The extent of any diversion of the
controlled substance in the class;
(6) Relevant information obtained
from the Department of Health and
Human Services (HHS), including from
the Food and Drug Administration
(FDA), the Centers for Disease Control
and Prevention (CDC), and the Centers
for Medicare and Medicaid Services
(CMS), and relevant information
obtained from the states; and
(7) Other factors affecting medical,
scientific, research, and industrial needs
in the United States and lawful export
requirements, as the Administrator finds
relevant, including changes in the
currently accepted medical use in
treatment with the class or the
substances manufactured from it, the
economic and physical availability of
raw materials for use in manufacturing
and for inventory purposes, yield and
stability problems, potential disruptions
to production (including possible labor
strikes), and recent unforeseen
emergencies such as floods and fires.
21 CFR 1303.11(b)
DEA formally solicited input from
FDA and CDC in February of 2023 and
from the states in April 2023, as
required by 21 U.S.C. 826 and 21 CFR
part 1303. DEA did not solicit input
from CMS for reasons discussed in
previous notices.1 DEA requested
information on trends in the legitimate
use of select schedule I and II controlled
substances from FDA and rates of
1 Proposed Adjustments to the Aggregate
Production Quotas for Schedule I and II Controlled
Substances and Assessment of Annual Needs for
List I Chemicals Ephedrine, Pseudoephedrine, and
Phenylpropanolamine for 2021, 85 FR 54414 (Sept.
1, 2020) and Proposed Aggregate Production Quotas
for Schedule I and II Controlled Substances and
Assessment of Annual Needs for List I Chemicals
Ephedrine, Pseudoephedrine, and
Phenylpropanolamine for 2021, 85 FR 54407 (Sept.
1, 2020).
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overdose deaths for covered controlled
substances from CDC. DEA’s request for
information from the states was made
directly to the Prescription Drug
Monitoring Program (PDMP)
Administrators in each state as well as
through the National Association of
State Controlled Substances Authorities
(NASCSA).
Assessment of Annual Needs
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In similar fashion, in determining the
proposed 2024 AAN for the list I
chemicals ephedrine, pseudoephedrine,
and phenylpropanolamine, the
Administrator has taken into account
the criteria of 21 U.S.C. 826(a) and 21
CFR 1315.11, including the five
following factors:
(1) Total net disposal of the chemical
by all manufacturers and importers
during the current and two preceding
years;
(2) Trends in the national rate of net
disposal of each chemical;
(3) Total actual (or estimated)
inventories of the chemical and of all
substances manufactured from the
chemical, and trends in inventory
accumulation;
(4) Projected demand for each
chemical as indicated by procurement
and import quotas requested pursuant to
[21 CFR] 1315.32; and
(5) Other factors affecting medical,
scientific, research, and industrial needs
in the United States, lawful export
requirements, and the establishment
and maintenance of reserve stocks, as
the Administrator finds relevant,
including changes in the currently
accepted medical use in treatment with
the chemicals or the substances
manufactured from them, the economic
and physical availability of raw
materials for use in manufacturing and
for inventory purposes, yield and
stability problems, potential disruptions
to production (including possible labor
strikes), and recent unforeseen
emergencies such as floods and fires.
21 CFR 1315.11(b)
In determining the proposed 2024
AAN, DEA used the calculation
methodology previously described in
the 2010 and 2011 assessments of
annual needs (74 FR 60294, Nov. 20,
2009, and 75 FR 79407, Dec. 20, 2010,
respectively).
Estimates of Medical Need for Schedule
II Opioids and Stimulants
In accordance with 21 CFR part 1303,
21 U.S.C. 826, and 42 U.S.C. 242, HHS
continues to provide DEA with
estimates of the quantities of select
schedule I and II controlled substances
and three list I chemicals that will be
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required to meet the legitimate medical
needs of the United States for a given
calendar year. The responsibility to
provide these estimates of legitimate
domestic medical needs resides with
FDA. FDA provides DEA with predicted
estimates of domestic medical usage for
selected controlled substances based on
information available to them at a
specific point in time in order to meet
statutory requirements.
FDA predicts that levels of medical
need for schedule II opioids in the
United States in calendar year 2024 will
decline on average 7.9 percent from
calendar year 2023 levels. These
declines are expected to occur across a
variety of schedule II opioids including
fentanyl, hydrocodone, hydromorphone,
oxycodone, and oxymorphone. DEA
considered the potential for diversion of
schedule II opioids, as required by 21
CFR 1303.11(b)(5), as well as a potential
increase in demand for certain opioids
identified as being necessary to support
the previously postponed elective
surgeries now that the COVID–19 public
health emergency has ended, pursuant
to 21 CFR 1303.11(b)(7), in developing
the proposed 2024 APQ.
FDA predicted an average of a 3.1
percent increase in domestic medical
use of the schedule II stimulants
amphetamine, methylphenidate
(including dexmethylphenidate), and
lisdexamfetamine, which are prescribed
to treat patients with attention deficit
hyperactivity disorder (ADHD) and
more recently prescribed off-label to
treat patients diagnosed with longCOVID symptoms commonly known as
brain fog where fatigue and cognitive
impairment persist 4 to 12 weeks after
a COVID infection.2 FDA also raised
concerns over drug shortage
notifications it received from patients
for specific ADHD medications
containing methylphenidate and
amphetamine. FDA’s stated reasons for
these specific shortages include
increased prescribing potentially related
to the growth in telemedicine, supply
chain issues, manufacturing and quality
issues, and business decisions of
manufacturers. DEA considered FDA’s
concerns when determining the APQ for
these substances. DEA believes that
manufacturers will be able to meet the
increase in domestic medical need with
the APQs proposed in this notice.
2 New Long-Haul COVID Clinics Treat Mysterious
and Ongoing Symptoms, Scientific American, June
30, 2021; Successful Treatment of Post-COVID–19
ADHD-like Syndrome-A case Report, J Atten
Disord., 2023 Aug; 27(10): 1092–1098.
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DEA Projected Trends for Certain
Schedule I Controlled Substances
There has been a significant increase
in the use of schedule I hallucinogenic
controlled substances for research and
clinical trial purposes. DEA has
received and subsequently approved
new registration applications for
schedule I researchers and new
applications for registration from
manufacturers to grow, synthesize,
extract, and prepare dosage forms
containing specific schedule I
hallucinogenic substances for research
and clinical trial purposes. DEA
supports regulated research with
schedule I controlled substances, as
evidenced by the higher APQ proposed
for 2024 as compared with APQ for
these substances in 2023. Further, DEA
published the final rule, ‘‘Controls to
Enhance the Cultivation of Marihuana
for Research in the United States’’ in
December 2020, and the Medical
Marijuana and Cannabidiol Research
Expansion Act (Pub. L. 117–215) was
enacted in December 2022. The agency
continues to review and approve
applications for schedule I
manufacturers of marihuana that
conform to the federal requirements
contained in the CSA. See 21 CFR part
1318.
Thus, DEA is proposing APQ for
ibogaine, psilocyn, psilocybin, delta-9tetrahydrocannabinol (d-9-THC), and all
other tetrahydrocannabinols to support
manufacturing activities related to the
increased level of research and clinical
trials with these schedule I controlled
substances. Additionally, DEA proposes
APQs for d-9-THC and all other
tetrahydrocannabinols for 2024 to
reflect the relocation of manufacturing
of these controlled substances from
abroad to the United States.
Information Received for Consideration
of the Remaining Factors
For the factors listed in 21 CFR
1303.11(b)(3) and (4), DEA registered
manufacturers of controlled substances
in schedules I and II provide
information such as inventory,
distribution, manufacturing, sales
forecasts and quota requests to the DEA
database systems. See 21 CFR 1303.12,
1303.22, and part 1304.
The regulation at 21 CFR
1303.11(b)(5) requires DEA to consider
the extent of diversion of controlled
substances.3 Diversion is defined as all
distribution, dispensing, or other use of
controlled substances for other than
legitimate medical purposes. In order to
3 The estimates of diversion for five ‘‘covered
controlled substances’’ as required by 21 U.S.C.
826(i) are discussed later in the document.
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consider the extent of diversion, DEA
analyzed reports of diversion of
controlled substances from 2022
submitted to its Theft Loss Report
database. This database is comprised of
DEA registrant reports documenting
diversion from the legitimate
distribution chain, including employee
thefts, break-ins, armed robberies, and
material lost in transit. The data was
categorized by basic drug class, and the
amount of active pharmaceutical
ingredient (API) in the dosage form was
delineated with an appropriate metric
for use in proposing aggregate
production quota values (i.e., weight).
In this proposed 2024 APQ, DEA also
considered the lingering effects of the
COVID–19 pandemic on the global
supply chain, pursuant to 21 CFR
1303.11(b)(7), and specifically the
continued impacts on the availability of
raw materials for use in the domestic
manufacturing process. Additionally,
DEA considered the impact of the
demand for surgical care for elective
surgeries that were deferred during the
COVID–19 public health emergency.
Estimates of Diversion of Covered
Controlled Substances
In establishing any quota . . . , or
any procurement quota established by
[DEA] by regulation, for fentanyl,
oxycodone, hydrocodone,
oxymorphone, or hydromorphone (in
this subsection referred to as a ‘‘covered
controlled substance’’), [DEA] shall
estimate the amount of diversion of the
covered controlled substance that
occurs in the United States.
21 U.S.C. 826(i)(1)(A)
In estimating diversion under that
provision, DEA:
(i) shall consider information . . . ,
in consultation with the Secretary of
Health and Human Services, [it]
determines reliable on rates of overdose
deaths and abuse and overall public
health impact related to the covered
controlled substance in the United
States; and
(ii) may take into consideration
whatever other sources of information
[it] determines reliable.
21 U.S.C. 826(i)(1)(B)
The statute further mandates that DEA
‘‘make appropriate quota reductions, as
determined by [DEA], from the quota [it]
would have otherwise established had
such diversion not been considered.’’ 4
In estimating the amount of diversion
of each covered controlled substance
that occurs in the United States, DEA
considered information from state
PDMP Administrators and from
4 21
U.S.C. 826(i)(1)(C).
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legitimate distribution chain
participants.
Consideration of Information From
Certain State PDMPs and From National
Sales Data
Pursuant to 21 CFR 1303.11(b)(6),
DEA requested state PDMP data for the
purpose of establishing its APQ. DEA
believes state PDMPs to be an essential,
reliable source of information for use in
effectively estimating diversion of the
five covered controlled substances. In
April 2023, DEA sent a letter to
NASCSA requesting its assistance in
obtaining aggregated PDMP data for the
five covered controlled substances from
each state covering the years 2020–2022.
The letter indicated that DEA was
specifically interested in an analysis of
prescription data from each state’s
PDMP that would assist DEA in
estimating diversion and setting
appropriate quotas in compliance with
21 U.S.C. 826(i). In its request, DEA
provided specific questions, discussed
in detail below, based on common
indicia of potential diversion known as
‘‘red flags’’ by physicians, pharmacists,
manufacturers, distributors, and federal
and state regulatory and law
enforcement agencies.5 DEA
investigators and administrative
prosecutors also rely on Agency case
law in which these red flags of diversion
have been upheld as indicia of potential
diversion.6 Certain state regulations
now include red flag circumstances as
potential indicators of illegitimate
prescriptions, and thus of potential
abuse and diversion of controlled
substances.7 See The Pharmacy Place
Order, 86 FR 21008, 21012 (Apr. 21,
2021) (citing 22 Tex. Admin. Code
291.29(c)(4), specifying the geographical
distance between the practitioner and
the patient or between the pharmacy
and the patient as a red flag).
DEA requested responses from state
PDMP Administrators by June 15, 2023.
NASCSA disseminated DEA’s request to
its PDMP Administrators and provided
them with a report tool to ensure that
responses to DEA’s questions were
extracted consistently across all
responsive states. Thirty states and two
5 National Association of Boards of Pharmacy
(NABP) coalition consensus document
‘‘Stakeholders’ Challenges and Red Flag Warning
Signs Related to Prescribing and Dispensing
Controlled Substances’’ (2015).
www.nabp.pharmacy/resources/reports.
6 The Medicine Shoppe, 79 FR 59504, 59507,
59512–13 (2014); Holiday CVS, L.L.C., d/b/a CVS
Pharmacy Nos. 219 and 5195, 77 FR 62316 (Oct. 12,
2012).
7 The mere indicia of red flags alone is not proof
of violation of 21 U.S.C. 824 or any other provision
of the CSA. This rule discusses only their use by
DEA as an analytical tool to estimate diversion.
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territories provided DEA with
summarized PDMP data between May 3,
and June 15, 2023, utilizing the
standardized report developed by
NASCSA.8 See Table 1a below.
TABLE 1a—STATES/TERRITORIES THAT
RESPONDED TO DEA’S DATA REQUEST
State/territory
1. Alabama
2. Alaska
3. Arizona
4. Arkansas
5. Connecticut
6. Delaware
7. District of Columbia
8. Hawaii
9. Idaho
10. Indiana
11. Iowa
12. Kansas
13. Kentucky
14. Louisiana
15. Maine
16. Maryland
17. Michigan
18. Minnesota
19. Mississippi
20. Montana
21. Nevada
22. New Jersey
23. North Carolina
24. North Dakota
25. Ohio
26. Oklahoma
27. Puerto Rico
28. Rhode Island
29. South Carolina
30. South Dakota
31. Texas
32. Utah
Pharmacies are required by state law
to enter controlled substance dispensing
data into the state’s PDMP database,
including the prescriber’s name,
registered address and DEA number;
prescription information (such as drug
name); dispensing date; dosage
dispensed; pharmacy registered address;
and patient name and address. DEA
considers PDMP data to be an accurate
representation of dispensing activities
in states. DEA received data for the
following red-flag metrics:
• The total number of patients who
saw three or more prescribers in a 90day period and were dispensed an
opioid following each visit. For this
metric, DEA requested and was
provided the number of prescriptions
for the five covered controlled
substances dispensed to these patients,
as a percentage of the total prescriptions
dispensed for that particular covered
controlled substance, as well as the
corresponding quantity of the covered
8 NASCSA formatted DEA’s request into an
analytics model developed by one of its associates,
Appriss Inc.
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khammond on DSKJM1Z7X2PROD with NOTICES
controlled substance dispensed. This
metric (patients being prescribed
covered controlled substances from
three or more prescribers in a 90-day
period) is used to identify potential
doctor shopping, a common technique
to obtain a high number of controlled
substances, which may lead to abuse or
diversion of controlled substances. DEA
has long considered doctor shopping to
be an indicator of potential diversion.9
• The number of patients that were
dispensed prescriptions for each of the
five covered controlled substances that
exceeded 240 morphine milligram
equivalents (MME) daily. States
provided the raw number of such
prescriptions dispensed, the number of
prescriptions as a percentage of the total
covered controlled substance
prescriptions dispensed, and the
corresponding quantity of the covered
controlled substance dispensed. DEA
believes that accounting for quantities
in excess of 240 MME daily allows for
consideration of oncology patients with
legitimate medical needs for covered
controlled substance prescriptions with
high MME. Higher dosages place
individuals at higher risk of overdose
and death. Prescriptions involving
dosages exceeding 240 MME daily may
indicate diversion, such as illegal
distribution of controlled substances or
prescribing outside the usual course of
professional practice.
• The number of patients that paid
cash for covered controlled substance
prescriptions, without submitting for
insurance reimbursement.10 States also
provided the number of prescriptions
paid entirely with cash as a percentage
of the total prescriptions for the five
covered controlled substances
dispensed, as well as the corresponding
quantity of the covered controlled
substances dispensed. When
investigating potential diversion, cash
payments are one element considered in
identifying prescriptions filled for
nonmedical purposes. Unusually high
percentages of cash payments made to a
prescriber or pharmacy for controlled
substances may indicate diversion.11
9 Frank’s Corner Pharmacy, 60 FR 17574 (1995);
Holiday CVS, L.L.C., d/b/a CVS Pharmacy Nos. 219
and 5195, 77 FR 62316 (Oct. 12, 2012).
10 This total does not include insurance copayments made with cash.
11 Suntree Pharmacy and Suntree Medical
Equipment, LLC, 85 FR 73753 (2018) (finding that
the pharmacy filled prescriptions despite the
presence of multiple unresolved red flags, including
cash payments); Pharmacy Doctors Enterprises d/b/
a Zion Clinic Pharmacy, 83 FR 10876 (Mar. 13,
2018) (revoking pharmacy’s registration for filling
prescriptions that raised the red flag of customers
paying cash for their prescriptions, among other red
flags).
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DEA received PDMP data from the
states in a standardized format that
allowed DEA to aggregate the data. The
PDMP data sample represents a
population of approximately 150.7
million people, which is approximately
45 percent of the U.S. population. DEA
believes this sample is sufficient to
derive a reasonable nationwide
estimate.
While PDMP data is useful in
estimating diversion, it is not
conclusive. Further investigation would
be required before concluding that any
of the subject prescriptions were
actually diverted. DEA continues to
evaluate its methodologies in estimating
diversion in an effort to adjust quotas
more efficiently. State participation is
crucial to accurate data analysis, and
DEA anticipates working closely with
states, as well as other federal and state
entities, in future quota determinations.
To calculate a national diversion
estimate for each of the covered
controlled substances from the
responses received from state PDMP
Administrators, DEA relied upon the
number of individuals who received a
prescription for a covered controlled
substance that met any of the three redflag metrics for each of calendar years
2020–2022. Using the population of the
states responding to DEA’s request, DEA
then calculated the percentage of the
population issued a prescription with a
red flag. Using this estimated percentage
for 2020–2022, DEA analyzed trends in
the data to predict the estimated
percentage of patients who would be
expected to be included in these red-flag
metrics for 2024.
DEA also reviewed aggregate sales
data for each of the covered controlled
substances, which it extracted from
IQVIA’s National Sales Perspective.12
IQVIA sales data was selected to help
quantify diversion at the national level
because it reflects the best national
estimate for all prescriptions written
and filled, including the total quantity
available for diversion or misuse. DEA
analyzed trends in IQVIA sales data
from January 2020—April 2023, in order
to predict the estimated national sales
for 2024.
To estimate diversion for each of the
covered controlled substances, DEA
multiplied the forecasted percentage of
patients likely to receive a prescription
for a covered controlled substance that
meet any of the three red-flag metrics in
2024 by the forecasted sales data from
IQVIA for 2024. The resulting estimate
12 DEA
has purchased this data from IQVIA for
decades and routinely uses this information to
administer several regulatory functions, including
the administration of DEA’s quota program.
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of diversion from data submitted by
state PDMP Administrators is
summarized below in Table 1b. This
data contributed to the final diversion
estimate set forth in Table 3.
TABLE 1B—DIVERSION ESTIMATES FOR
2024 BASED ON STATE PDMP
DATA FOR COVERED CONTROLLED
SUBSTANCES FROM 2020–2022
Controlled substance
Fentanyl ................................
Hydrocodone ........................
Hydromorphone ....................
Oxycodone ............................
Oxymorphone .......................
(g)
18
83,823
356
150,684
0
Consideration of Registrant Reported
Diversion in the Legitimate Distribution
Chain
DEA extracted data from its Theft
Loss Report database and categorized it
by each basic drug class. DEA calculated
the estimated amount of diversion by
multiplying the quantity of API in each
finished dosage form by the total
amount of units reported stolen or lost
to estimate the metric weight in grams
of the controlled substance being
diverted. This estimate of diversion
from the legitimate supply chain for
each of the covered controlled
substances is displayed in Table 2. This
data contributed to the final diversion
estimates set forth in Table 3.
TABLE 2—DIVERSION ESTIMATES
BASED ON SUPPLY CHAIN DIVERSION DATA FOR COVERED CONTROLLED SUBSTANCES
Controlled Substance
Fentanyl ................................
Hydrocodone ........................
Hydromorphone ....................
Oxycodone ............................
Oxymorphone .......................
(g)
74
12,454
481
31,698
252
In accordance with 21 U.S.C. 826(i),
DEA’s estimate of diversion for the five
controlled substances was calculated by
combining the values in Tables 1b and
2. DEA reduced the APQ for each
covered controlled substance by the
quantities listed in Table 3.
TABLE 3—TOTAL ESTIMATES OF DIVERSION
FOR
COVERED CONTROLLED SUBSTANCES TO BE APPLIED TO THE 2024 APQS
Controlled substance
Fentanyl ................................
Hydrocodone ........................
Hydromorphone ....................
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92
96,277
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Federal Register / Vol. 88, No. 211 / Thursday, November 2, 2023 / Notices
as compared to mixed-salt amphetamine
products which may be indicative of
product switching from amphetamine to
methylphenidate and
dexmethylphendiate. Neither DEA nor
FDA anticipated these changes.
In addition to these demographic
Controlled substance
(g)
shifts in prescribing, DEA also evaluated
Oxycodone ............................
182,382 inventory, manufacturing, and sales
Oxymorphone .......................
252 data submitted by manufacturers
through ARCOS and through reports
Forthcoming Regulatory Changes and
submitted to DEA’s Quota Management
Administration of Individual Quotas
System. That analysis revealed that
for 2024
dosage manufacturers of amphetamine
DEA is committed to ensuring that all did not utilize the full extent of their
authorized quotas. DEA authorized
Americans can access appropriately
amphetamine medication dosage form
prescribed medications. As part of this
manufacturers across the entire market
commitment, DEA undertook work to
to purchase and use 38,418 kilograms of
understand the supply chain dynamics
amphetamine but those manufacturers
for controlled substances subject to
initially 15 reported the purchase of only
quotas over the last year and a half,
31,539 kg. Of that quantity, dosage
especially in highly genericized
manufacturers only shipped 26,953 kg
markets. Based on that review, DEA
observed various challenges in the quota of amphetamine medications.
This ongoing work has led DEA to
allocation process stemming from the
conclude that changes to its regulations
lack of real-time inventory and sales
likely will be useful in developing more
data accessible to DEA, the lack of
precise quotas that will provide for the
information on manufacturers’
estimated medical, scientific, research,
production lead times, and issues of
and industrial needs of the United
timeliness in ARCOS reporting.
States, for lawful export requirements,
Relatedly, beginning in the latter half
and for the establishment and
of 2022, the DEA and FDA observed an
increase in the number of drug shortages maintenance of reserve stocks, while
reported by manufacturers of schedule II also reducing opportunities for
stimulants including mixed-salt
diversion. For instance, DEA believes
amphetamine products starting in April that changes to reporting requirements
2022 and lisdexamfetamine and
are necessary to improve both the type
methylphenidate starting in July 2023.
of data collected and the timeliness of
As DEA and FDA stated in their open
that data, allowing DEA to be more
letter,13 we remain committed to doing
nimble in its administration of the quota
all we can to prevent stimulant drug
program. Future regulatory changes may
shortages, limit their impact, and
seek to address the lack of real-time
resolve them as quickly as possible.
inventory and sales data accessible to
DEA commissioned two reports by
DEA, the lack of information on
IQVIA 14 in order to understand the
production lead times, and issues of
demographic shifts impacting the
timeliness in ARCOS reporting, by
prescribing of schedule II stimulants.
considering, for example, requiring
The reports provided valuable insights.
manufacturers to provide anticipated
Chief among those insights was the
production timelines and monthly
observed increase in prescriptions
ARCOS reporting. DEA is not seeking
dispensed for mixed-salt amphetamine
comments on these concepts through
products to adults between the ages of
this notice, but will publish detailed
31–40 years, particularly women, and
proposals for comment in the future.
older patients (71–80 years old),
DEA also will seek additional
particularly during the COVID–19
information that will assist the agency
pandemic (i.e. 2020 and 2021). In
to more accurately forecast export
contrast, during 2022, dispensed
requirements, especially for those
prescriptions for products containing
substances that are not controlled
methylphenidate HCl and
dexmethylphenidate HCl had a higher
15 In July 2023, several manufacturers who—
annual increase in 2022 (than in 2021)
according to their reporting to DEA—had failed to
khammond on DSKJM1Z7X2PROD with NOTICES
TABLE 3—TOTAL ESTIMATES OF DIVERSION
FOR
COVERED CONTROLLED SUBSTANCES TO BE APPLIED TO THE 2024 APQS—Continued
13 Both DEA and FDA released this letter on Aug.
1, 2023. It is available at: https://www.dea.gov/sites/
default/files/2023-08/DEA%20and
%20FDA%20Issue%20Joint%20Letter
%20to%20the%20Public.pdf.
14 Both reports are available at: https://
www.deadiversion.usdoj.gov/drug_chem_info/
stimulants/.
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use their full amphetamine procurement quotas in
2022 received correspondence from DEA and FDA
asking them to confirm that they would use their
full 2023 procurement quotas. Upon receiving that
correspondence—approximately seven months after
the close of calendar year 2022—one such
manufacturer then revised its 2022 reporting to
DEA to reflect that it had, in fact, used nearly all
of its 2022 amphetamine procurement quota.
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75317
internationally.16 DEA understands that
manufacturers have contractual
obligations that dictate business
decisions regarding the quantities of
finished dosage forms they will produce
under a single DEA-issued quota, which
applies to products manufactured with
an active ingredient, whether for
domestic or foreign markets. DEA also is
exploring the purchase of third-party
data to improve its understanding of the
dynamic changes in foreign markets.
Building off the recently issued quota
management rule,17 DEA also intends to
add new subcategories to individual
manufacturing quotas and procurement
quotas, to distinguish between domestic
requirements and export requirements.
DEA also is considering methods by
which it might increase transparency in
its quota setting process. Future
regulatory proposals may define
additional steps, including such
concepts as public notification and an
opportunity for public input when
prescribing rates for controlled
substances deviate substantially from
FDA’s estimate of future use.
Furthermore, DEA is considering
regulatory changes which will authorize
it to reduce a manufacturer’s individual
manufacturing or procurement quota in
order to apportion it to another
manufacturer. As with the regulatory
changes mentioned above, DEA will
welcome comment on detailed
proposals in the future, and is not
requesting comment on these general
concepts in this notice.
The abovementioned regulatory
changes will take time. In the meantime,
for the 2024 quota year, DEA intends to
allocate procurement quotas to DEAregistered manufacturers of schedule II
controlled substances on a quarterly
basis. In order to address domestic drug
shortages of controlled substances,
procurement quota allocations for
schedule II controlled substances will
be divided between quantities
authorized for domestic sales and
quantities authorized for export sales.
DEA will be sending a letter to each
manufacturer with instructions on the
data that will be necessary to allow DEA
to process subsequent quarterly
procurement quota allocations. DEA
may publish or post how many
companies have been allocated quota in
16 While amphetamine and methylphenidate are
currently recognized as schedule II controlled
substances under the Convention on Psychotropic
Substances of 1971, lisdexamfetamine is not.
Additional details may be found at: https://
www.incb.org/incb/en/psychotropics/1971_
convention.html.
17 Management of Quotas for Controlled
Substances and List I Chemicals, 88 FR 60117 (Aug.
31, 2023) (effective Nov. 29, 2023).
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a given calendar year, and how many of
those companies have utilized their
allocated quota. Further, DEA may
publish or post the names of the
companies that have been allocated
quota.
The Administrator, therefore,
proposes to establish the 2024 APQ for
certain schedule I and II controlled
substances and AAN for the list I
chemicals ephedrine, pseudoephedrine,
and phenylpropanolamine, expressed in
grams of anhydrous acid or base, as
follows:
Proposed
2024 quotas
Basic class
(g)
khammond on DSKJM1Z7X2PROD with NOTICES
Schedule I
-[1-(2-Thienyl)cyclohexyl]pyrrolidine ....................................................................................................................................................
1-(1-Phenylcyclohexyl)pyrrolidine ........................................................................................................................................................
1-(2-Phenylethyl)-4-phenyl-4-acetoxypiperidine ..................................................................................................................................
1-(5-Fluoropentyl)-3-(1-naphthoyl)indole (AM2201) ............................................................................................................................
1-(5-Fluoropentyl)-3-(2-iodobenzoyl)indole (AM694) ...........................................................................................................................
1-[1-(2-Thienyl)cyclohexyl]piperidine ...................................................................................................................................................
2′-fluoro 2-fluorofentanyl ......................................................................................................................................................................
1-Benzylpiperazine ..............................................................................................................................................................................
1-Methyl-4-phenyl-4-propionoxypiperidine ...........................................................................................................................................
2-(2,5-Dimethoxy-4-ethylphenyl)ethanamine (2C–E) ..........................................................................................................................
2-(2,5-Dimethoxy-4-methylphenyl)ethanamine (2C–D) .......................................................................................................................
2-(2,5-Dimethoxy-4-nitro-phenyl)ethanamine (2C–N) .........................................................................................................................
2-(2,5-Dimethoxy-4-n-propylphenyl)ethanamine (2C–P) .....................................................................................................................
2-(2,5-Dimethoxyphenyl)ethanamine (2C–H) ......................................................................................................................................
2-(4-Bromo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25B–NBOMe; 2C–B–NBOMe; 25B; Cimbi-36) ......................
2-(4-Chloro-2,5-dimethoxyphenyl)ethanamine (2C–C) ........................................................................................................................
2-(4-Chloro-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25C–NBOMe; 2C–C–NBOMe; 25C; Cimbi-82) .....................
2-(4-Iodo-2,5-dimethoxyphenyl)ethanamine (2C–I) .............................................................................................................................
2-(4-Iodo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine (25I–NBOMe; 2C–I–NBOMe; 25I; Cimbi-5) ................................
2,5-Dimethoxy-4-ethylamphetamine (DOET) ......................................................................................................................................
2,5-Dimethoxy-4-n-propylthiophenethylamine .....................................................................................................................................
2,5-Dimethoxyamphetamine ................................................................................................................................................................
2-[4-(Ethylthio)-2,5-dimethoxyphenyl]ethanamine (2C–T–2) ...............................................................................................................
2-[4-(Isopropylthio)-2,5-dimethoxyphenyl]ethanamine (2C–T–4) ........................................................................................................
3,4,5-Trimethoxyamphetamine ............................................................................................................................................................
3,4-Methylenedioxyamphetamine (MDA) ............................................................................................................................................
3,4-Methylenedioxymethamphetamine (MDMA) .................................................................................................................................
3,4-Methylenedioxy-N-ethylamphetamine (MDEA) .............................................................................................................................
3,4-Methylenedioxy-N-methylcathinone (methylone) ..........................................................................................................................
3,4-Methylenedioxypyrovalerone (MDPV) ...........................................................................................................................................
3–FMC; 3-Fluoro-N-methylcathinone ..................................................................................................................................................
3-Methylfentanyl ...................................................................................................................................................................................
3-Methylthiofentanyl .............................................................................................................................................................................
4,4′-Dimethylaminorex .........................................................................................................................................................................
4-Bromo-2,5-dimethoxyamphetamine (DOB) ......................................................................................................................................
4-Bromo-2,5-dimethoxyphenethylamine (2–CB) .................................................................................................................................
4-Chloro-alpha-pyrrolidinovalerophenone (4-chloro-alpha-PVP) .........................................................................................................
4–CN-Cumyl-Butinaca .........................................................................................................................................................................
4-Fluoroisobutyryl fentanyl ...................................................................................................................................................................
4F–MDMB–BINACA ............................................................................................................................................................................
4–FMC; Flephedrone ...........................................................................................................................................................................
4–MEC; 4-Methyl-N-ethylcathinone .....................................................................................................................................................
4-Methoxyamphetamine ......................................................................................................................................................................
4-Methyl-2,5-dimethoxyamphetamine (DOM) ......................................................................................................................................
4-Methylaminorex ................................................................................................................................................................................
4-Methyl-N-methylcathinone (mephedrone) ........................................................................................................................................
4-Methyl-alpha-ethylaminopentiophenone (4–MEAP) .........................................................................................................................
4-Methyl-alpha-pyrrolidinohexiophenone (MPHP) ...............................................................................................................................
4′-Methyl acetyl fentanyl ......................................................................................................................................................................
4-Methyl-a-pyrrolidinopropiophenone (4-MePPP) ...............................................................................................................................
5-(1,1-Dimethylheptyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol .........................................................................................................
5-(1,1-Dimethyloctyl)-2-[(1R,3S)-3-hydroxycyclohexyl]-phenol (cannabicyclohexanol or CP–47,497 C8-homolog) ..........................
5F–AB–PINACA; (1-Amino-3-methyl-1-oxobutan-2-yl)-1-(5-fluoropentyl)-1H-indazole-3-carboxamide .............................................
5F–ADB; 5F–MDMB–PINACA (methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate) ..........................
5F–CUMYL–P7AICA; 1-(5-Fluoropentyl)-N-(2-phenylpropan-2-yl)-1H-pyrrolo[2,3-b]pyridine-3carboximide ......................................
5F–CUMYL–PINACA ...........................................................................................................................................................................
5F–EDMB–PINACA .............................................................................................................................................................................
5F–MDMB–PICA .................................................................................................................................................................................
5F–AMB (methyl 2-(1-(5-fluoropentyl)-1H-indazole-3-carboxamido)-3-methylbutanoate) ..................................................................
5F–APINACA; 5F–AKB48 (N-(adamantan-1-yl)-1-(5-fluoropentyl)-1H-indazole-3-carboxamide) .......................................................
5-Fluoro-PB–22; 5F–PB–22 ................................................................................................................................................................
5-Fluoro-UR144, XLR11 ([1-(5-fluoro-pentyl)-1Hindol-3-yl](2,2,3,3-tetramethylcyclopropyl)methanone ............................................
5-Methoxy-3,4-methylenedioxyamphetamine ......................................................................................................................................
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E:\FR\FM\02NON1.SGM
02NON1
20
30
10
30
30
15
30
25
10
30
30
30
30
100
30
30
25
30
30
25
25
25
30
30
30
12,000
12,000
40
5,200
35
25
30
30
30
30
5,100
25
25
30
30
25
25
150
25
25
45
25
25
30
25
50
40
25
25
25
25
25
25
25
25
25
25
25
Federal Register / Vol. 88, No. 211 / Thursday, November 2, 2023 / Notices
75319
Proposed
2024 quotas
Basic class
khammond on DSKJM1Z7X2PROD with NOTICES
(g)
5-Methoxy-N,N-diisopropyltryptamine ..................................................................................................................................................
5-Methoxy-N,N-dimethyltryptamine .....................................................................................................................................................
AB–CHMINACA ...................................................................................................................................................................................
AB–FUBINACA ....................................................................................................................................................................................
AB–PINACA .........................................................................................................................................................................................
ADB–FUBINACA (N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(4-fluorobenzyl)-1H-indazole-3-carboxamide) .................................
Acetorphine ..........................................................................................................................................................................................
Acetyl Fentanyl ....................................................................................................................................................................................
Acetyl-alpha-methylfentanyl .................................................................................................................................................................
Acetyldihydrocodeine ...........................................................................................................................................................................
Acetylmethadol ....................................................................................................................................................................................
Acryl Fentanyl ......................................................................................................................................................................................
ADB–PINACA (N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-pentyl-1H-indazole-3-carboxamide) .....................................................
AH–7921 ..............................................................................................................................................................................................
All other tetrahydrocannabinol .............................................................................................................................................................
Allylprodine ..........................................................................................................................................................................................
Alphacetylmethadol ..............................................................................................................................................................................
alpha-Ethyltryptamine ..........................................................................................................................................................................
Alphameprodine ...................................................................................................................................................................................
Alphamethadol .....................................................................................................................................................................................
alpha-Methylfentanyl ............................................................................................................................................................................
alpha-Methylthiofentanyl ......................................................................................................................................................................
alpha-Methyltryptamine (AMT) ............................................................................................................................................................
alpha-Pyrrolidinobutiophenone (a-PBP) ..............................................................................................................................................
alpha-pyrrolidinoheptaphenone (PV8) .................................................................................................................................................
alpha-pyrrolidinohexabophenone (alpha-PHP) ....................................................................................................................................
alpha-Pyrrolidinopentiophenone (a-PVP) ............................................................................................................................................
Amineptine ...........................................................................................................................................................................................
Aminorex ..............................................................................................................................................................................................
Anileridine ............................................................................................................................................................................................
APINCA, AKB48 (N-(1-adamantyl)-1-pentyl-1H-indazole-3-carboxamide) .........................................................................................
Benzethidine ........................................................................................................................................................................................
Benzylmorphine ...................................................................................................................................................................................
Betacetylmethadol ...............................................................................................................................................................................
beta-Hydroxy-3-methylfentanyl ............................................................................................................................................................
beta-Hydroxyfentanyl ...........................................................................................................................................................................
beta-Hydroxythiofentanyl .....................................................................................................................................................................
beta-Methyl fentanyl ............................................................................................................................................................................
beta′-Phenyl fentanyl ...........................................................................................................................................................................
Betameprodine .....................................................................................................................................................................................
Betamethadol .......................................................................................................................................................................................
Betaprodine ..........................................................................................................................................................................................
Brorphine .............................................................................................................................................................................................
Bufotenine ............................................................................................................................................................................................
Butonitazene ........................................................................................................................................................................................
Butylone ...............................................................................................................................................................................................
Butyryl fentanyl ....................................................................................................................................................................................
Cathinone .............................................................................................................................................................................................
Clonitazene ..........................................................................................................................................................................................
Codeine methylbromide .......................................................................................................................................................................
Codeine-N-oxide ..................................................................................................................................................................................
Crotonyl Fentanyl .................................................................................................................................................................................
Cyclopentyl Fentanyl ...........................................................................................................................................................................
Cyclopropyl Fentanyl ...........................................................................................................................................................................
Cyprenorphine .....................................................................................................................................................................................
d-9–THC ..............................................................................................................................................................................................
Desomorphine ......................................................................................................................................................................................
Dextromoramide ..................................................................................................................................................................................
Diapromide ...........................................................................................................................................................................................
Diethylthiambutene ..............................................................................................................................................................................
Diethyltryptamine .................................................................................................................................................................................
Difenoxin ..............................................................................................................................................................................................
Dihydromorphine ..................................................................................................................................................................................
Dimenoxadol ........................................................................................................................................................................................
Dimepheptanol .....................................................................................................................................................................................
Dimethylthiambutene ...........................................................................................................................................................................
Dimethyltryptamine ..............................................................................................................................................................................
Dioxyaphetyl butyrate ..........................................................................................................................................................................
Dipipanone ...........................................................................................................................................................................................
Drotebanol ...........................................................................................................................................................................................
Ethylmethylthiambutene .......................................................................................................................................................................
VerDate Sep<11>2014
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E:\FR\FM\02NON1.SGM
02NON1
25
11,000
30
50
30
30
25
100
30
30
25
25
50
30
790,010
25
25
25
25
25
30
30
25
25
25
25
25
30
25
20
25
25
30
25
30
30
30
30
30
25
4
25
30
15
30
25
30
40
25
30
192
25
30
20
25
900,610
25
25
20
20
25
9,300
639,954
25
25
20
3,000
25
25
25
25
75320
Federal Register / Vol. 88, No. 211 / Thursday, November 2, 2023 / Notices
Proposed
2024 quotas
Basic class
khammond on DSKJM1Z7X2PROD with NOTICES
(g)
Ethylone ...............................................................................................................................................................................................
Etodesnitazene ....................................................................................................................................................................................
Etonitazene ..........................................................................................................................................................................................
Etorphine ..............................................................................................................................................................................................
Etoxeridine ...........................................................................................................................................................................................
Eutylone ...............................................................................................................................................................................................
Fenethylline ..........................................................................................................................................................................................
Fentanyl carbamate .............................................................................................................................................................................
Fentanyl related substances ................................................................................................................................................................
Flunitazene ..........................................................................................................................................................................................
FUB–144 ..............................................................................................................................................................................................
FUB–AKB48 .........................................................................................................................................................................................
Fub-AMB, MMB-Fubinaca, AMB-Fubinaca .........................................................................................................................................
Furanyl fentanyl ...................................................................................................................................................................................
Furethidine ...........................................................................................................................................................................................
gamma-Hydroxybutyric acid ................................................................................................................................................................
Heroin ..................................................................................................................................................................................................
Hydromorphinol ....................................................................................................................................................................................
Hydroxypethidine .................................................................................................................................................................................
Ibogaine ...............................................................................................................................................................................................
Isobutyryl Fentanyl ...............................................................................................................................................................................
Isotonitazine .........................................................................................................................................................................................
JWH–018 and AM678 (1-Pentyl-3-(1-naphthoyl)indole) .....................................................................................................................
JWH–019 (1-Hexyl-3-(1-naphthoyl)indole) ..........................................................................................................................................
JWH–073 (1-Butyl-3-(1-naphthoyl)indole) ...........................................................................................................................................
JWH–081 (1-Pentyl-3-[1-(4-methoxynaphthoyl)]indole) ......................................................................................................................
JWH–122 (1-Pentyl-3-(4-methyl-1-naphthoyl)indole) ..........................................................................................................................
JWH–200 (1-[2-(4-Morpholinyl)ethyl]-3-(1-naphthoyl)indole) ..............................................................................................................
JWH–203 (1-Pentyl-3-(2-chlorophenylacetyl)indole) ...........................................................................................................................
JWH–250 (1-Pentyl-3-(2-methoxyphenylacetyl)indole) .......................................................................................................................
JWH–398 (1-Pentyl-3-(4-chloro-1-naphthoyl)indole) ...........................................................................................................................
Ketobemidone ......................................................................................................................................................................................
Levomoramide .....................................................................................................................................................................................
Levophenyacylmorphan .......................................................................................................................................................................
Lysergic acid diethylamide (LSD) ........................................................................................................................................................
MAB–CHMINACA; ADB–CHMINACA (N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(cyclohexylmethyl)-1H-indazole-3carboxamide) ....................................................................................................................................................................................
MDMB–CHMICA; MMB–CHMINACA(methyl 2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3,3-dimethylbutanoate) ...............
MDMB–FUBINACA (methyl 2-(1-(4-fluorobenzyl)-1H-indazole-3-carboxamido)-3,3-dimethylbutanoate) ..........................................
MMB–CHMICA-(AMB–CHIMCA); Methyl-2-(1-(cyclohexylmethyl)-1H-indole-3-carboxamido)-3-methylbutanoate ............................
Mesocarb .............................................................................................................................................................................................
Metodesnitazene ..................................................................................................................................................................................
Metonitazene .......................................................................................................................................................................................
Marijuana .............................................................................................................................................................................................
Marijuana extract .................................................................................................................................................................................
Mecloqualone .......................................................................................................................................................................................
Mescaline .............................................................................................................................................................................................
Methaqualone ......................................................................................................................................................................................
Methcathinone .....................................................................................................................................................................................
Methiopropamine .................................................................................................................................................................................
Methoxetamine ....................................................................................................................................................................................
Methoxyacetyl fentanyl ........................................................................................................................................................................
Methyldesorphine .................................................................................................................................................................................
Methyldihydromorphine ........................................................................................................................................................................
Morpheridine ........................................................................................................................................................................................
Morphine methylbromide .....................................................................................................................................................................
Morphine methylsulfonate ....................................................................................................................................................................
Morphine-N-oxide ................................................................................................................................................................................
MT–45 ..................................................................................................................................................................................................
Myrophine ............................................................................................................................................................................................
NM2201: Naphthalen-1-yl 1-(5-fluorpentyl)-1H-indole-3-carboxylate ..................................................................................................
N,N-Dimethylamphetamine ..................................................................................................................................................................
Naphyrone ...........................................................................................................................................................................................
N-Ethyl-1-phenylcyclohexylamine ........................................................................................................................................................
N-Ethyl-3-piperidyl benzilate ................................................................................................................................................................
N-Ethylamphetamine ...........................................................................................................................................................................
N-Ethylhexedrone ................................................................................................................................................................................
N-Ethylpentylone, ephylone .................................................................................................................................................................
N-Hydroxy-3,4-methylenedioxyamphetamine ......................................................................................................................................
Nicocodeine .........................................................................................................................................................................................
Nicomorphine .......................................................................................................................................................................................
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02NON1
25
30
25
30
25
30
30
30
600
30
25
25
25
30
25
29,417,000
150
40
25
150
25
25
35
45
45
30
30
35
30
30
30
30
25
25
1,200
30
30
30
25
30
30
30
6,675,000
1,000,000
30
1,200
60
25
30
30
30
5
25
25
5
5
150
30
25
25
25
25
25
10
24
25
30
24
25
25
Federal Register / Vol. 88, No. 211 / Thursday, November 2, 2023 / Notices
75321
Proposed
2024 quotas
Basic class
(g)
N-methyl-3-piperidyl benzilate .............................................................................................................................................................
N-Pyrrolidino Etonitazene ....................................................................................................................................................................
Noracymethadol ...................................................................................................................................................................................
Norlevorphanol .....................................................................................................................................................................................
Normethadone .....................................................................................................................................................................................
Normorphine ........................................................................................................................................................................................
Norpipanone ........................................................................................................................................................................................
Ocfentanil .............................................................................................................................................................................................
ortho-Fluoroacryl fentanyl ....................................................................................................................................................................
ortho-Fluorobutyryl fentanyl .................................................................................................................................................................
Ortho-Fluorofentanyl,2-Fluorofentanyl .................................................................................................................................................
ortho-Fluoroisobutyryl fentanyl ............................................................................................................................................................
ortho-Methyl acetylfentanyl ..................................................................................................................................................................
ortho-Methyl methoxyacetyl fentanyl ...................................................................................................................................................
Para-Chlorisobutyrl fentanyl ................................................................................................................................................................
Para-flourobutyryl fentanyl ...................................................................................................................................................................
Para-fluorofentanyl ...............................................................................................................................................................................
para-Fluoro furanyl fentanyl .................................................................................................................................................................
Para-Methoxybutyrl fentanyl ................................................................................................................................................................
Para-methoxymethamphetamine .........................................................................................................................................................
para-Methylfentanyl .............................................................................................................................................................................
Parahexyl .............................................................................................................................................................................................
PB–22; QUPIC .....................................................................................................................................................................................
Pentedrone ..........................................................................................................................................................................................
Pentylone .............................................................................................................................................................................................
Phenadoxone .......................................................................................................................................................................................
Phenampromide ...................................................................................................................................................................................
Phenomorphan ....................................................................................................................................................................................
Phenoperidine ......................................................................................................................................................................................
Phenyl fentanyl ....................................................................................................................................................................................
Pholcodine ...........................................................................................................................................................................................
Piritramide ............................................................................................................................................................................................
Proheptazine ........................................................................................................................................................................................
Properidine ...........................................................................................................................................................................................
Propiram ..............................................................................................................................................................................................
Protonitazene .......................................................................................................................................................................................
Psilocybin .............................................................................................................................................................................................
Psilocyn ................................................................................................................................................................................................
Racemoramide .....................................................................................................................................................................................
SR–18 and RCS–8 (1-Cyclohexylethyl-3-(2-methoxyphenylacetyl)indole) .........................................................................................
SR–19 and RCS–4 (1-Pentyl-3-[(4-methoxy)-benzoyl]indole) ............................................................................................................
Tetrahydrofuranyl fentanyl ...................................................................................................................................................................
Thebacon .............................................................................................................................................................................................
Thiafentanil ..........................................................................................................................................................................................
Thiofentanyl .........................................................................................................................................................................................
Thiofuranyl fentanyl .............................................................................................................................................................................
THJ–2201 ( [1-(5-fluoropentyl)-1H-indazol-3-yl](naphthalen-1-yl)methanone) ....................................................................................
Tilidine ..................................................................................................................................................................................................
Trimeperidine .......................................................................................................................................................................................
UR–144 (1-pentyl-1H-indol-3-yl)(2,2,3,3-tetramethylcyclopropyl)methanone .....................................................................................
U–47700 ..............................................................................................................................................................................................
Valeryl fentanyl ....................................................................................................................................................................................
Zipeprol ................................................................................................................................................................................................
30
30
25
2,550
25
40
25
25
30
30
30
30
30
30
30
25
25
30
30
30
30
5
20
25
25
25
25
25
25
30
5
25
25
25
25
30
15,000
24,000
25
45
30
15
25
25
25
30
30
25
25
25
30
25
30
khammond on DSKJM1Z7X2PROD with NOTICES
Schedule II
1-Phenylcyclohexylamine ....................................................................................................................................................................
1-Piperidinocyclohexanecarbonitrile ....................................................................................................................................................
4-Anilino-N-phenethyl-4-piperidine (ANPP) .........................................................................................................................................
Alfentanil ..............................................................................................................................................................................................
Alphaprodine ........................................................................................................................................................................................
Amobarbital ..........................................................................................................................................................................................
Bezitramide ..........................................................................................................................................................................................
Carfentanil ............................................................................................................................................................................................
Cocaine ................................................................................................................................................................................................
Codeine (for conversion) .....................................................................................................................................................................
Codeine (for sale) ................................................................................................................................................................................
d-amphetamine (for sale) ....................................................................................................................................................................
d,l-amphetamine ..................................................................................................................................................................................
d-amphetamine (for conversion) ..........................................................................................................................................................
Dexmethylphenidate (for sale) .............................................................................................................................................................
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15
25
866,746
5,000
25
20,100
25
20
60,492
942,452
19,262,957
21,200,000
21,200,000
20,000,000
6,200,000
75322
Federal Register / Vol. 88, No. 211 / Thursday, November 2, 2023 / Notices
Proposed
2024 quotas
Basic class
(g)
khammond on DSKJM1Z7X2PROD with NOTICES
Dexmethylphenidate (for conversion) ..................................................................................................................................................
Dextropropoxyphene ............................................................................................................................................................................
Dihydrocodeine ....................................................................................................................................................................................
Dihydroetorphine ..................................................................................................................................................................................
Diphenoxylate (for conversion) ............................................................................................................................................................
Diphenoxylate (for sale) .......................................................................................................................................................................
Ecgonine ..............................................................................................................................................................................................
Ethylmorphine ......................................................................................................................................................................................
Etorphine hydrochloride .......................................................................................................................................................................
Fentanyl ...............................................................................................................................................................................................
Glutethimide .........................................................................................................................................................................................
Hydrocodone (for conversion) .............................................................................................................................................................
Hydrocodone (for sale) ........................................................................................................................................................................
Hydromorphone ...................................................................................................................................................................................
Isomethadone ......................................................................................................................................................................................
L-amphetamine ....................................................................................................................................................................................
Levo-alphacetylmethadol (LAAM) ........................................................................................................................................................
Levomethorphan ..................................................................................................................................................................................
Levorphanol .........................................................................................................................................................................................
Lisdexamfetamine ................................................................................................................................................................................
Meperidine ...........................................................................................................................................................................................
Meperidine Intermediate-A ..................................................................................................................................................................
Meperidine Intermediate-B ..................................................................................................................................................................
Meperidine Intermediate-C ..................................................................................................................................................................
Metazocine ...........................................................................................................................................................................................
Methadone (for sale) ...........................................................................................................................................................................
Methadone Intermediate ......................................................................................................................................................................
d,l-Methamphetamine ..........................................................................................................................................................................
d-methamphetamine (for conversion) ..................................................................................................................................................
d-methamphetamine (for sale) ............................................................................................................................................................
l-methamphetamine .............................................................................................................................................................................
Methylphenidate (for sale) ...................................................................................................................................................................
Methylphenidate (for conversion) ........................................................................................................................................................
Metopon ...............................................................................................................................................................................................
Moramide-intermediate ........................................................................................................................................................................
Morphine (for conversion) ....................................................................................................................................................................
Morphine (for sale) ..............................................................................................................................................................................
Nabilone ...............................................................................................................................................................................................
Norfentanyl ...........................................................................................................................................................................................
Noroxymorphone (for conversion) .......................................................................................................................................................
Noroxymorphone (for sale) ..................................................................................................................................................................
Oliceridine ............................................................................................................................................................................................
Opium (powder) ...................................................................................................................................................................................
Opium (tincture) ...................................................................................................................................................................................
Oripavine ..............................................................................................................................................................................................
Oxycodone (for conversion) ................................................................................................................................................................
Oxycodone (for sale) ...........................................................................................................................................................................
Oxymorphone (for conversion) ............................................................................................................................................................
Oxymorphone (for sale) .......................................................................................................................................................................
Pentobarbital ........................................................................................................................................................................................
Phenazocine ........................................................................................................................................................................................
Phencyclidine .......................................................................................................................................................................................
Phenmetrazine .....................................................................................................................................................................................
Phenylacetone .....................................................................................................................................................................................
Piminodine ...........................................................................................................................................................................................
Racemethorphan .................................................................................................................................................................................
Racemorphan ......................................................................................................................................................................................
Remifentanil .........................................................................................................................................................................................
Secobarbital .........................................................................................................................................................................................
Sufentanil .............................................................................................................................................................................................
Tapentadol ...........................................................................................................................................................................................
Thebaine ..............................................................................................................................................................................................
4,200,000
35
115,227
25
14,100
770,800
60,492
30
32
676,062
25
1,250
27,143,545
1,951,801
30
30
25
30
20,000
26,500,000
681,184
30
30
30
15
25,619,700
27,673,600
150
485,020
47,000
587,229
53,283,000
19,975,468
25
25
2,393,200
20,805,957
62,000
25
22,044,741
1,000
25,100
250,000
530,837
33,010,750
437,827
53,658,226
28,204,371
464,464
33,843,337
25
35
25
100
25
5
5
3,000
172,100
4,000
10,390,226
57,137,944
List I Chemicals
Ephedrine (for conversion) ..................................................................................................................................................................
Ephedrine (for sale) .............................................................................................................................................................................
Phenylpropanolamine (for conversion) ................................................................................................................................................
Phenylpropanolamine (for sale) ...........................................................................................................................................................
Pseudoephedrine (for conversion) ......................................................................................................................................................
Pseudoephedrine (for sale) .................................................................................................................................................................
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41,100
3,933,336
14,878,320
7,990,000
1,000
170,360,314
Federal Register / Vol. 88, No. 211 / Thursday, November 2, 2023 / Notices
The Administrator further proposes
that aggregate production quotas for all
other schedule I and II controlled
substances included in 21 CFR 1308.11
and 1308.12 remain at zero.
These proposed 2024 quotas reflect
the quantities that DEA believes are
necessary to meet the estimated
medical, scientific, research, and
industrial needs of the United States,
lawful export requirements; and the
establishment and maintenance of
reserve stocks. DEA remains committed
to conducting continuous surveillance
on the supply of schedule II controlled
substances and list I chemicals
necessary to treat patients with COVID–
19, and, pursuant to her authority, the
Administrator will move swiftly and
decisively to increase any 2024 APQ
that she determines is necessary to
address an unforeseen increase in
demand, should that occur.
In accordance with 21 CFR 1303.13
and 1315.13, upon consideration of the
relevant factors, the Administrator may
adjust the 2024 APQ and AAN as
needed.
Conclusion
After consideration of any comments
or objections, or after a hearing, if one
is held, the Administrator will issue and
publish in the Federal Register a final
order establishing the 2024 APQ for
controlled substances in schedules I and
II and establishing an AAN for the list
I chemicals ephedrine,
pseudoephedrine, and
phenylpropanolamine, as directed by 21
CFR 1303.11(c) and 1315.11(f).
khammond on DSKJM1Z7X2PROD with NOTICES
Signing Authority
This document of the Drug
Enforcement Administration was signed
on October 30, 2023, by Administrator
Anne Milgram. That document with the
original signature and date is
maintained by DEA. For administrative
purposes only, and in compliance with
requirements of the Office of the Federal
Register, the undersigned DEA Federal
Register Liaison Officer has been
authorized to sign and submit the
document in electronic format for
publication, as an official document of
DEA. This administrative process in no
way alters the legal effect of this
document upon publication in the
Federal Register.
Scott Brinks,
Federal Register Liaison Officer, Drug
Enforcement Administration.
[FR Doc. 2023–24282 Filed 11–1–23; 8:45 am]
BILLING CODE P
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75323
Drug Enforcement Administration
findings of fact, conclusions of law,
sanctions analysis, and recommended
sanction as found in the RD.
[Docket No. 23–17]
I. Findings of Fact
Isaac Sved, M.D.; Decision and Order
Georgia Standard of Care
DEA hired Dr. Lobel to testify as an
expert in the standard of care for the
practice of medicine and the prescribing
of controlled substances in the state of
Georgia, with a focus on pain
management. RD, at 4; Tr. 105.3 Dr.
Lobel defined ‘‘standard of care’’ as a
‘‘minimum level of competence or care
so as not to harm the patient,’’ and
described how the Georgia standard of
care requires a practitioner to, prior to
prescribing controlled substances,
obtain a patient’s prior medical records;
obtain a medical history, including
family medical history and mental
health history; conduct an appropriate
physical examination; obtain a urine
drug screen; check the PDMP; obtain
informed consent from the patient; and
document all information. RD, at 11; Tr.
120, 128–129, 134, 136. Further, the
physical examination must be
appropriate to the complaint, and for
patients who have spinal pain, the
practitioner should also conduct a
complete neurologic exam. RD, at 11;
Tr. 129–130. In addition, the Georgia
standard of care requires that a
practitioner determine and document
the severity of pain. RD, at 11; Tr. 135–
136.
Dr. Lobel testified that under the
Georgia standard of care, opioids ‘‘are
not first-line treatment for chronic
pain,’’ so a practitioner must ‘‘weigh the
risks and benefits at every visit,’’ as well
as look out for adverse effects, side
effects, and aberrant behavior. RD, at 11;
Tr. 132–133, 136–137. According to Dr.
Lobel, under the Georgia standard of
care, a practitioner should consider
taking a patient off of opioids when
there is a ‘‘lack of functional benefit,
toxic effects of the medicine where
they’re having end organ damage, . . .
[or] someone [] showing any signs or
symptoms of addiction,’’ and patients
DEPARTMENT OF JUSTICE
On December 8, 2022, the Drug
Enforcement Administration (DEA or
Government) issued an Order to Show
Cause and Immediate Suspension of
Registration (OSC/ISO) to Isaac Sved,
M.D. (Respondent) of Buford, Georgia.
OSC/ISO, at 1. The OSC/ISO informed
Respondent of the immediate
suspension of his DEA Certificate of
Registration, Control No. BS4103610,
pursuant to 21 U.S.C. 824(d), alleging
that Respondent’s continued registration
constitutes ‘‘ ‘an imminent danger to the
public health or safety.’ ’’ Id. (quoting 21
U.S.C. 824(d)). The OSC/ISO also
proposed the revocation of
Respondent’s registration, alleging that
Respondent has ‘‘committed such acts
as would render [his] registration
inconsistent with the public interest.’’
Id. at 1, 4 (citing 21 U.S.C. 823(g)(1),1
824(a)(4)).
A hearing was held before DEA
Administrative Law Judge Teresa A.
Wallbaum (the ALJ) who, on June 20,
2023, issued her Recommended Rulings,
Findings of Fact, Conclusions of Law,
and Decision (Recommended Decision
or RD), which recommended revocation
of Respondent’s registration. RD, at 27.
Respondent did not file exceptions to
the RD. Having reviewed the entire
record, the Agency adopts and hereby
incorporates by reference the entirety of
the ALJ’s rulings, credibility findings,2
1 Effective December 2, 2022, the Medical
Marijuana and Cannabidiol Research Expansion
Act, Public Law 117–215, 136 Stat. 2257 (2022)
(Marijuana Research Amendments or MRA),
amended the Controlled Substances Act (CSA) and
other statutes. Relevant to this matter, the MRA
redesignated 21 U.S.C. 823(f), cited in the OSC/ISO,
as 21 U.S.C. 823(g)(1). Accordingly, this Decision
cites to the current designation, 21 U.S.C. 823(g)(1),
and to the MRA-amended CSA throughout.
2 The Agency adopts the ALJ’s summary of each
of the witnesses’ testimonies as well as the ALJ’s
assessment of each of the witnesses’ credibility. See
RD, at 3–17. The Agency agrees with the ALJ that
the Diversion Investigator’s testimony, which was
focused on the uncontroversial introduction of
documentary evidence and her contact with the
case, was credible in that it was sufficiently
detailed, plausible, and internally consistent. Id. at
4. Further, the Agency agrees with the ALJ that the
testimony from the Government’s expert witness,
Dr. Steven Lobel, M.D., which was focused on the
Georgia standard of care and Respondent’s
prescribing to the patients listed in the OSC/ISO,
was credible in that it was consistent with Georgia
statutes governing the prescribing of controlled
substances, especially in the pain management
context, and was clear, direct, substantial, and
consistent with regards to the individual patients.
Id. at 4–5. Finally, the Agency agrees with the ALJ
that although Respondent’s testimony was credible
as to general facts, including Respondent
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volunteering information regarding prior
disciplinary actions, on the issue of whether his
prescriptions were within the usual course of
professional practice and for a legitimate medical
purpose, Respondent’s testimony was not fully
credible in that his interpretations of the Georgia
standard of care were inconsistent with the Georgia
state statutes. Id. at 9–10.
3 During the hearing, both Government counsel
and Dr. Lobel initially referenced a national
standard of care established by the CDC Guidelines,
see RD, at 10, but Dr. Lobel ultimately testified that
the Georgia standard of care, upon which this
decision is based, is grounded in the state medical
board’s publications and Georgia state statutes, with
the CDC Guidelines incorporated to the extent that
they deal with the prescriptions of opioids. RD, at
10; Tr. 114–115, 119, 125.
E:\FR\FM\02NON1.SGM
02NON1
Agencies
[Federal Register Volume 88, Number 211 (Thursday, November 2, 2023)]
[Notices]
[Pages 75312-75323]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2023-24282]
-----------------------------------------------------------------------
DEPARTMENT OF JUSTICE
Drug Enforcement Administration
[Docket No. DEA-1228P]
Proposed Aggregate Production Quotas for Schedule I and II
Controlled Substances and Assessment of Annual Needs for the List I
Chemicals Ephedrine, Pseudoephedrine, and Phenylpropanolamine for 2024
AGENCY: Drug Enforcement Administration, Department of Justice.
ACTION: Notice with request for comments.
-----------------------------------------------------------------------
SUMMARY: The Drug Enforcement Administration (DEA) proposes to
establish the 2024 aggregate production quotas (APQ) for controlled
substances in schedules I and II of the Controlled Substances Act (CSA)
and the assessment of annual needs (AAN) for the list I chemicals
ephedrine, pseudoephedrine, and phenylpropanolamine. For the 2024 quota
year, DEA intends to allocate procurement quotas to DEA-registered
manufacturers of schedule II controlled substances on a quarterly
basis. In order to address domestic drug shortages of controlled
substances, procurement quota allocations will be divided between
quantities authorized for domestic sales and quantities authorized for
export sales.
DATES: Electronic comments must be submitted, and written comments must
be postmarked, on or before December 4, 2023. Interested persons may
file written comments on this notice in accordance with 21 CFR
1303.11(c) and 1315.11(d). Commenters should be aware that the
electronic Federal Docket Management System will not accept comments
after 11:59 p.m. Eastern Time on the last day of the comment period.
Based on comments received in response to this notice, the
Administrator may hold a public hearing on one or more issues raised.
In the event the Administrator decides in her sole discretion to hold
such a hearing, the Administrator will publish a notice of any such
hearing in the Federal Register. After consideration of any comments or
objections, or after a hearing, if one is held, the Administrator will
publish in the Federal Register a final order establishing the 2024
aggregate production quotas for schedule I and II controlled
substances, and an assessment of annual needs for the list I chemicals
ephedrine, pseudoephedrine, and phenylpropanolamine.
[[Page 75313]]
ADDRESSES: To ensure proper handling of comments, please reference
``Docket No. DEA-1228P'' on all correspondence, including any
attachments. DEA encourages that all comments be submitted
electronically through the Federal eRulemaking Portal, which provides
the ability to type short comments directly into the comment field on
the web page or attach a file for lengthier comments. Please go to
https://www.regulations.gov and follow the online instructions at that
site for submitting comments. Upon completion of your submission, you
will receive a Comment Tracking Number for your comment. Please be
aware that submitted comments are not instantaneously available for
public view on Regulations.gov. If you have received a Comment Tracking
Number, your comment has been successfully submitted, and there is no
need to resubmit the same comment. Paper comments that duplicate
electronic submissions are not necessary and are discouraged. Should
you wish to mail a paper comment in lieu of an electronic comment, it
should be sent via regular or express mail to: Drug Enforcement
Administration, Attention: DEA Federal Register Representative/DPW,
8701 Morrissette Drive, Springfield, Virginia 22152.
FOR FURTHER INFORMATION CONTACT: Scott A. Brinks, Regulatory Drafting
and Policy Support Section, Diversion Control Division, Drug
Enforcement Administration; Mailing Address: 8701 Morrissette Drive,
Springfield, Virginia 22152, Telephone: (571) 776-3882.
SUPPLEMENTARY INFORMATION:
Posting of Public Comments
Please note that all comments received in response to this docket
are considered part of the public record. They will, unless reasonable
cause is given, be made available by the Drug Enforcement
Administration (DEA) for public inspection online at https://www.regulations.gov. Such information includes personal identifying
information (such as your name, address, etc.) voluntarily submitted by
the commenter.
The Freedom of Information Act applies to all comments received. If
you want to submit personal identifying information (such as your name,
address, etc.) as part of your comment, but do not want it to be made
publicly available, you must include the phrase ``PERSONAL IDENTIFYING
INFORMATION'' in the first paragraph of your comment. You must also
place all the personal identifying information you do not want made
publicly available in the first paragraph of your comment and identify
what information you want redacted.
If you want to submit confidential business information as part of
your comment, but do not want it to be made publicly available, you
must include the phrase ``CONFIDENTIAL BUSINESS INFORMATION'' in the
first paragraph of your comment. You must also prominently identify
confidential business information to be redacted within the comment.
Comments containing personal identifying information or
confidential business information identified and located as directed
above will generally be made available in redacted form. If a comment
contains so much confidential business information or personal
identifying information that it cannot be effectively redacted, all or
part of that comment may not be made publicly available. Comments
posted to https://www.regulations.gov may include any personal
identifying information (such as name, address, and phone number)
included in the text of your electronic submission that is not
identified as directed above as confidential.
An electronic copy of this document is available at https://www.regulations.gov for easy reference.
Legal Authority
Section 306 of the Controlled Substances Act (21 U.S.C. 826)
requires the Attorney General to establish production quotas for each
basic class of controlled substances listed in schedules I and II, and
for the list I chemicals ephedrine, pseudoephedrine, and
phenylpropanolamine. The Attorney General has delegated this function
to the Administrator of DEA pursuant to 28 CFR 0.100.
Analysis for Proposed 2024 Aggregate Production Quotas and Assessment
of Annual Needs
The proposed 2024 aggregate production quotas (APQ) and assessment
of annual needs (AAN) represent those quantities of schedule I and II
controlled substances, and the list I chemicals ephedrine,
pseudoephedrine, and phenylpropanolamine, to be manufactured in the
United States (U.S.) in 2024 to provide for the estimated medical,
scientific, research, and industrial needs of the United States, lawful
export requirements, and the establishment and maintenance of reserve
stocks. These quotas include imports of ephedrine, pseudoephedrine, and
phenylpropanolamine, but do not include imports of controlled
substances for use in industrial processes.
Aggregate Production Quotas
In determining the proposed 2024 APQ, the Administrator has taken
into account the criteria of 21 U.S.C. 826(a) and 21 CFR 1303.11,
including the following seven factors:
(1) Total net disposal of the class by all manufacturers during the
current and two preceding years;
(2) Trends in the national rate of net disposal of the class;
(3) Total actual (or estimated) inventories of the class and of all
substances manufactured from the class, and trends in inventory
accumulation;
(4) Projected demand for such class as indicated by procurement
quotas requested pursuant to [21 CFR] 1303.12;
(5) The extent of any diversion of the controlled substance in the
class;
(6) Relevant information obtained from the Department of Health and
Human Services (HHS), including from the Food and Drug Administration
(FDA), the Centers for Disease Control and Prevention (CDC), and the
Centers for Medicare and Medicaid Services (CMS), and relevant
information obtained from the states; and
(7) Other factors affecting medical, scientific, research, and
industrial needs in the United States and lawful export requirements,
as the Administrator finds relevant, including changes in the currently
accepted medical use in treatment with the class or the substances
manufactured from it, the economic and physical availability of raw
materials for use in manufacturing and for inventory purposes, yield
and stability problems, potential disruptions to production (including
possible labor strikes), and recent unforeseen emergencies such as
floods and fires.
21 CFR 1303.11(b)
DEA formally solicited input from FDA and CDC in February of 2023
and from the states in April 2023, as required by 21 U.S.C. 826 and 21
CFR part 1303. DEA did not solicit input from CMS for reasons discussed
in previous notices.\1\ DEA requested information on trends in the
legitimate use of select schedule I and II controlled substances from
FDA and rates of
[[Page 75314]]
overdose deaths for covered controlled substances from CDC. DEA's
request for information from the states was made directly to the
Prescription Drug Monitoring Program (PDMP) Administrators in each
state as well as through the National Association of State Controlled
Substances Authorities (NASCSA).
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\1\ Proposed Adjustments to the Aggregate Production Quotas for
Schedule I and II Controlled Substances and Assessment of Annual
Needs for List I Chemicals Ephedrine, Pseudoephedrine, and
Phenylpropanolamine for 2021, 85 FR 54414 (Sept. 1, 2020) and
Proposed Aggregate Production Quotas for Schedule I and II
Controlled Substances and Assessment of Annual Needs for List I
Chemicals Ephedrine, Pseudoephedrine, and Phenylpropanolamine for
2021, 85 FR 54407 (Sept. 1, 2020).
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Assessment of Annual Needs
In similar fashion, in determining the proposed 2024 AAN for the
list I chemicals ephedrine, pseudoephedrine, and phenylpropanolamine,
the Administrator has taken into account the criteria of 21 U.S.C.
826(a) and 21 CFR 1315.11, including the five following factors:
(1) Total net disposal of the chemical by all manufacturers and
importers during the current and two preceding years;
(2) Trends in the national rate of net disposal of each chemical;
(3) Total actual (or estimated) inventories of the chemical and of
all substances manufactured from the chemical, and trends in inventory
accumulation;
(4) Projected demand for each chemical as indicated by procurement
and import quotas requested pursuant to [21 CFR] 1315.32; and
(5) Other factors affecting medical, scientific, research, and
industrial needs in the United States, lawful export requirements, and
the establishment and maintenance of reserve stocks, as the
Administrator finds relevant, including changes in the currently
accepted medical use in treatment with the chemicals or the substances
manufactured from them, the economic and physical availability of raw
materials for use in manufacturing and for inventory purposes, yield
and stability problems, potential disruptions to production (including
possible labor strikes), and recent unforeseen emergencies such as
floods and fires.
21 CFR 1315.11(b)
In determining the proposed 2024 AAN, DEA used the calculation
methodology previously described in the 2010 and 2011 assessments of
annual needs (74 FR 60294, Nov. 20, 2009, and 75 FR 79407, Dec. 20,
2010, respectively).
Estimates of Medical Need for Schedule II Opioids and Stimulants
In accordance with 21 CFR part 1303, 21 U.S.C. 826, and 42 U.S.C.
242, HHS continues to provide DEA with estimates of the quantities of
select schedule I and II controlled substances and three list I
chemicals that will be required to meet the legitimate medical needs of
the United States for a given calendar year. The responsibility to
provide these estimates of legitimate domestic medical needs resides
with FDA. FDA provides DEA with predicted estimates of domestic medical
usage for selected controlled substances based on information available
to them at a specific point in time in order to meet statutory
requirements.
FDA predicts that levels of medical need for schedule II opioids in
the United States in calendar year 2024 will decline on average 7.9
percent from calendar year 2023 levels. These declines are expected to
occur across a variety of schedule II opioids including fentanyl,
hydrocodone, hydromorphone, oxycodone, and oxymorphone. DEA considered
the potential for diversion of schedule II opioids, as required by 21
CFR 1303.11(b)(5), as well as a potential increase in demand for
certain opioids identified as being necessary to support the previously
postponed elective surgeries now that the COVID-19 public health
emergency has ended, pursuant to 21 CFR 1303.11(b)(7), in developing
the proposed 2024 APQ.
FDA predicted an average of a 3.1 percent increase in domestic
medical use of the schedule II stimulants amphetamine, methylphenidate
(including dexmethylphenidate), and lisdexamfetamine, which are
prescribed to treat patients with attention deficit hyperactivity
disorder (ADHD) and more recently prescribed off-label to treat
patients diagnosed with long-COVID symptoms commonly known as brain fog
where fatigue and cognitive impairment persist 4 to 12 weeks after a
COVID infection.\2\ FDA also raised concerns over drug shortage
notifications it received from patients for specific ADHD medications
containing methylphenidate and amphetamine. FDA's stated reasons for
these specific shortages include increased prescribing potentially
related to the growth in telemedicine, supply chain issues,
manufacturing and quality issues, and business decisions of
manufacturers. DEA considered FDA's concerns when determining the APQ
for these substances. DEA believes that manufacturers will be able to
meet the increase in domestic medical need with the APQs proposed in
this notice.
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\2\ New Long-Haul COVID Clinics Treat Mysterious and Ongoing
Symptoms, Scientific American, June 30, 2021; Successful Treatment
of Post-COVID-19 ADHD-like Syndrome-A case Report, J Atten Disord.,
2023 Aug; 27(10): 1092-1098.
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DEA Projected Trends for Certain Schedule I Controlled Substances
There has been a significant increase in the use of schedule I
hallucinogenic controlled substances for research and clinical trial
purposes. DEA has received and subsequently approved new registration
applications for schedule I researchers and new applications for
registration from manufacturers to grow, synthesize, extract, and
prepare dosage forms containing specific schedule I hallucinogenic
substances for research and clinical trial purposes. DEA supports
regulated research with schedule I controlled substances, as evidenced
by the higher APQ proposed for 2024 as compared with APQ for these
substances in 2023. Further, DEA published the final rule, ``Controls
to Enhance the Cultivation of Marihuana for Research in the United
States'' in December 2020, and the Medical Marijuana and Cannabidiol
Research Expansion Act (Pub. L. 117-215) was enacted in December 2022.
The agency continues to review and approve applications for schedule I
manufacturers of marihuana that conform to the federal requirements
contained in the CSA. See 21 CFR part 1318.
Thus, DEA is proposing APQ for ibogaine, psilocyn, psilocybin,
delta-9-tetrahydrocannabinol (d-9-THC), and all other
tetrahydrocannabinols to support manufacturing activities related to
the increased level of research and clinical trials with these schedule
I controlled substances. Additionally, DEA proposes APQs for d-9-THC
and all other tetrahydrocannabinols for 2024 to reflect the relocation
of manufacturing of these controlled substances from abroad to the
United States.
Information Received for Consideration of the Remaining Factors
For the factors listed in 21 CFR 1303.11(b)(3) and (4), DEA
registered manufacturers of controlled substances in schedules I and II
provide information such as inventory, distribution, manufacturing,
sales forecasts and quota requests to the DEA database systems. See 21
CFR 1303.12, 1303.22, and part 1304.
The regulation at 21 CFR 1303.11(b)(5) requires DEA to consider the
extent of diversion of controlled substances.\3\ Diversion is defined
as all distribution, dispensing, or other use of controlled substances
for other than legitimate medical purposes. In order to
[[Page 75315]]
consider the extent of diversion, DEA analyzed reports of diversion of
controlled substances from 2022 submitted to its Theft Loss Report
database. This database is comprised of DEA registrant reports
documenting diversion from the legitimate distribution chain, including
employee thefts, break-ins, armed robberies, and material lost in
transit. The data was categorized by basic drug class, and the amount
of active pharmaceutical ingredient (API) in the dosage form was
delineated with an appropriate metric for use in proposing aggregate
production quota values (i.e., weight).
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\3\ The estimates of diversion for five ``covered controlled
substances'' as required by 21 U.S.C. 826(i) are discussed later in
the document.
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In this proposed 2024 APQ, DEA also considered the lingering
effects of the COVID-19 pandemic on the global supply chain, pursuant
to 21 CFR 1303.11(b)(7), and specifically the continued impacts on the
availability of raw materials for use in the domestic manufacturing
process. Additionally, DEA considered the impact of the demand for
surgical care for elective surgeries that were deferred during the
COVID-19 public health emergency.
Estimates of Diversion of Covered Controlled Substances
In establishing any quota . . . , or any procurement quota
established by [DEA] by regulation, for fentanyl, oxycodone,
hydrocodone, oxymorphone, or hydromorphone (in this subsection referred
to as a ``covered controlled substance''), [DEA] shall estimate the
amount of diversion of the covered controlled substance that occurs in
the United States.
21 U.S.C. 826(i)(1)(A)
In estimating diversion under that provision, DEA:
(i) shall consider information . . . , in consultation with the
Secretary of Health and Human Services, [it] determines reliable on
rates of overdose deaths and abuse and overall public health impact
related to the covered controlled substance in the United States; and
(ii) may take into consideration whatever other sources of
information [it] determines reliable.
21 U.S.C. 826(i)(1)(B)
The statute further mandates that DEA ``make appropriate quota
reductions, as determined by [DEA], from the quota [it] would have
otherwise established had such diversion not been considered.'' \4\
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\4\ 21 U.S.C. 826(i)(1)(C).
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In estimating the amount of diversion of each covered controlled
substance that occurs in the United States, DEA considered information
from state PDMP Administrators and from legitimate distribution chain
participants.
Consideration of Information From Certain State PDMPs and From National
Sales Data
Pursuant to 21 CFR 1303.11(b)(6), DEA requested state PDMP data for
the purpose of establishing its APQ. DEA believes state PDMPs to be an
essential, reliable source of information for use in effectively
estimating diversion of the five covered controlled substances. In
April 2023, DEA sent a letter to NASCSA requesting its assistance in
obtaining aggregated PDMP data for the five covered controlled
substances from each state covering the years 2020-2022. The letter
indicated that DEA was specifically interested in an analysis of
prescription data from each state's PDMP that would assist DEA in
estimating diversion and setting appropriate quotas in compliance with
21 U.S.C. 826(i). In its request, DEA provided specific questions,
discussed in detail below, based on common indicia of potential
diversion known as ``red flags'' by physicians, pharmacists,
manufacturers, distributors, and federal and state regulatory and law
enforcement agencies.\5\ DEA investigators and administrative
prosecutors also rely on Agency case law in which these red flags of
diversion have been upheld as indicia of potential diversion.\6\
Certain state regulations now include red flag circumstances as
potential indicators of illegitimate prescriptions, and thus of
potential abuse and diversion of controlled substances.\7\ See The
Pharmacy Place Order, 86 FR 21008, 21012 (Apr. 21, 2021) (citing 22
Tex. Admin. Code 291.29(c)(4), specifying the geographical distance
between the practitioner and the patient or between the pharmacy and
the patient as a red flag).
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\5\ National Association of Boards of Pharmacy (NABP) coalition
consensus document ``Stakeholders' Challenges and Red Flag Warning
Signs Related to Prescribing and Dispensing Controlled Substances''
(2015). www.nabp.pharmacy/resources/reports.
\6\ The Medicine Shoppe, 79 FR 59504, 59507, 59512-13 (2014);
Holiday CVS, L.L.C., d/b/a CVS Pharmacy Nos. 219 and 5195, 77 FR
62316 (Oct. 12, 2012).
\7\ The mere indicia of red flags alone is not proof of
violation of 21 U.S.C. 824 or any other provision of the CSA. This
rule discusses only their use by DEA as an analytical tool to
estimate diversion.
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DEA requested responses from state PDMP Administrators by June 15,
2023. NASCSA disseminated DEA's request to its PDMP Administrators and
provided them with a report tool to ensure that responses to DEA's
questions were extracted consistently across all responsive states.
Thirty states and two territories provided DEA with summarized PDMP
data between May 3, and June 15, 2023, utilizing the standardized
report developed by NASCSA.\8\ See Table 1a below.
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\8\ NASCSA formatted DEA's request into an analytics model
developed by one of its associates, Appriss Inc.
Table 1a--States/Territories That Responded to DEA's Data Request
------------------------------------------------------------------------
State/territory
-------------------------------------------------------------------------
1. Alabama
2. Alaska
3. Arizona
4. Arkansas
5. Connecticut
6. Delaware
7. District of Columbia
8. Hawaii
9. Idaho
10. Indiana
11. Iowa
12. Kansas
13. Kentucky
14. Louisiana
15. Maine
16. Maryland
17. Michigan
18. Minnesota
19. Mississippi
20. Montana
21. Nevada
22. New Jersey
23. North Carolina
24. North Dakota
25. Ohio
26. Oklahoma
27. Puerto Rico
28. Rhode Island
29. South Carolina
30. South Dakota
31. Texas
32. Utah
------------------------------------------------------------------------
Pharmacies are required by state law to enter controlled substance
dispensing data into the state's PDMP database, including the
prescriber's name, registered address and DEA number; prescription
information (such as drug name); dispensing date; dosage dispensed;
pharmacy registered address; and patient name and address. DEA
considers PDMP data to be an accurate representation of dispensing
activities in states. DEA received data for the following red-flag
metrics:
The total number of patients who saw three or more
prescribers in a 90-day period and were dispensed an opioid following
each visit. For this metric, DEA requested and was provided the number
of prescriptions for the five covered controlled substances dispensed
to these patients, as a percentage of the total prescriptions dispensed
for that particular covered controlled substance, as well as the
corresponding quantity of the covered
[[Page 75316]]
controlled substance dispensed. This metric (patients being prescribed
covered controlled substances from three or more prescribers in a 90-
day period) is used to identify potential doctor shopping, a common
technique to obtain a high number of controlled substances, which may
lead to abuse or diversion of controlled substances. DEA has long
considered doctor shopping to be an indicator of potential
diversion.\9\
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\9\ Frank's Corner Pharmacy, 60 FR 17574 (1995); Holiday CVS,
L.L.C., d/b/a CVS Pharmacy Nos. 219 and 5195, 77 FR 62316 (Oct. 12,
2012).
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The number of patients that were dispensed prescriptions
for each of the five covered controlled substances that exceeded 240
morphine milligram equivalents (MME) daily. States provided the raw
number of such prescriptions dispensed, the number of prescriptions as
a percentage of the total covered controlled substance prescriptions
dispensed, and the corresponding quantity of the covered controlled
substance dispensed. DEA believes that accounting for quantities in
excess of 240 MME daily allows for consideration of oncology patients
with legitimate medical needs for covered controlled substance
prescriptions with high MME. Higher dosages place individuals at higher
risk of overdose and death. Prescriptions involving dosages exceeding
240 MME daily may indicate diversion, such as illegal distribution of
controlled substances or prescribing outside the usual course of
professional practice.
The number of patients that paid cash for covered
controlled substance prescriptions, without submitting for insurance
reimbursement.\10\ States also provided the number of prescriptions
paid entirely with cash as a percentage of the total prescriptions for
the five covered controlled substances dispensed, as well as the
corresponding quantity of the covered controlled substances dispensed.
When investigating potential diversion, cash payments are one element
considered in identifying prescriptions filled for nonmedical purposes.
Unusually high percentages of cash payments made to a prescriber or
pharmacy for controlled substances may indicate diversion.\11\
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\10\ This total does not include insurance co-payments made with
cash.
\11\ Suntree Pharmacy and Suntree Medical Equipment, LLC, 85 FR
73753 (2018) (finding that the pharmacy filled prescriptions despite
the presence of multiple unresolved red flags, including cash
payments); Pharmacy Doctors Enterprises d/b/a Zion Clinic Pharmacy,
83 FR 10876 (Mar. 13, 2018) (revoking pharmacy's registration for
filling prescriptions that raised the red flag of customers paying
cash for their prescriptions, among other red flags).
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DEA received PDMP data from the states in a standardized format
that allowed DEA to aggregate the data. The PDMP data sample represents
a population of approximately 150.7 million people, which is
approximately 45 percent of the U.S. population. DEA believes this
sample is sufficient to derive a reasonable nationwide estimate.
While PDMP data is useful in estimating diversion, it is not
conclusive. Further investigation would be required before concluding
that any of the subject prescriptions were actually diverted. DEA
continues to evaluate its methodologies in estimating diversion in an
effort to adjust quotas more efficiently. State participation is
crucial to accurate data analysis, and DEA anticipates working closely
with states, as well as other federal and state entities, in future
quota determinations.
To calculate a national diversion estimate for each of the covered
controlled substances from the responses received from state PDMP
Administrators, DEA relied upon the number of individuals who received
a prescription for a covered controlled substance that met any of the
three red-flag metrics for each of calendar years 2020-2022. Using the
population of the states responding to DEA's request, DEA then
calculated the percentage of the population issued a prescription with
a red flag. Using this estimated percentage for 2020-2022, DEA analyzed
trends in the data to predict the estimated percentage of patients who
would be expected to be included in these red-flag metrics for 2024.
DEA also reviewed aggregate sales data for each of the covered
controlled substances, which it extracted from IQVIA's National Sales
Perspective.\12\ IQVIA sales data was selected to help quantify
diversion at the national level because it reflects the best national
estimate for all prescriptions written and filled, including the total
quantity available for diversion or misuse. DEA analyzed trends in
IQVIA sales data from January 2020--April 2023, in order to predict the
estimated national sales for 2024.
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\12\ DEA has purchased this data from IQVIA for decades and
routinely uses this information to administer several regulatory
functions, including the administration of DEA's quota program.
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To estimate diversion for each of the covered controlled
substances, DEA multiplied the forecasted percentage of patients likely
to receive a prescription for a covered controlled substance that meet
any of the three red-flag metrics in 2024 by the forecasted sales data
from IQVIA for 2024. The resulting estimate of diversion from data
submitted by state PDMP Administrators is summarized below in Table 1b.
This data contributed to the final diversion estimate set forth in
Table 3.
Table 1B--Diversion Estimates for 2024 Based on State PDMP Data for
Covered Controlled Substances From 2020-2022
------------------------------------------------------------------------
Controlled substance (g)
------------------------------------------------------------------------
Fentanyl................................................ 18
Hydrocodone............................................. 83,823
Hydromorphone........................................... 356
Oxycodone............................................... 150,684
Oxymorphone............................................. 0
------------------------------------------------------------------------
Consideration of Registrant Reported Diversion in the Legitimate
Distribution Chain
DEA extracted data from its Theft Loss Report database and
categorized it by each basic drug class. DEA calculated the estimated
amount of diversion by multiplying the quantity of API in each finished
dosage form by the total amount of units reported stolen or lost to
estimate the metric weight in grams of the controlled substance being
diverted. This estimate of diversion from the legitimate supply chain
for each of the covered controlled substances is displayed in Table 2.
This data contributed to the final diversion estimates set forth in
Table 3.
Table 2--Diversion Estimates Based on Supply Chain Diversion Data for
Covered Controlled Substances
------------------------------------------------------------------------
Controlled Substance (g)
------------------------------------------------------------------------
Fentanyl................................................ 74
Hydrocodone............................................. 12,454
Hydromorphone........................................... 481
Oxycodone............................................... 31,698
Oxymorphone............................................. 252
------------------------------------------------------------------------
In accordance with 21 U.S.C. 826(i), DEA's estimate of diversion
for the five controlled substances was calculated by combining the
values in Tables 1b and 2. DEA reduced the APQ for each covered
controlled substance by the quantities listed in Table 3.
Table 3--Total Estimates of Diversion for Covered Controlled Substances
To Be Applied to the 2024 APQs
------------------------------------------------------------------------
Controlled substance (g)
------------------------------------------------------------------------
Fentanyl................................................ 92
Hydrocodone............................................. 96,277
Hydromorphone........................................... 838
[[Page 75317]]
Oxycodone............................................... 182,382
Oxymorphone............................................. 252
------------------------------------------------------------------------
Forthcoming Regulatory Changes and Administration of Individual Quotas
for 2024
DEA is committed to ensuring that all Americans can access
appropriately prescribed medications. As part of this commitment, DEA
undertook work to understand the supply chain dynamics for controlled
substances subject to quotas over the last year and a half, especially
in highly genericized markets. Based on that review, DEA observed
various challenges in the quota allocation process stemming from the
lack of real-time inventory and sales data accessible to DEA, the lack
of information on manufacturers' production lead times, and issues of
timeliness in ARCOS reporting.
Relatedly, beginning in the latter half of 2022, the DEA and FDA
observed an increase in the number of drug shortages reported by
manufacturers of schedule II stimulants including mixed-salt
amphetamine products starting in April 2022 and lisdexamfetamine and
methylphenidate starting in July 2023. As DEA and FDA stated in their
open letter,\13\ we remain committed to doing all we can to prevent
stimulant drug shortages, limit their impact, and resolve them as
quickly as possible.
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\13\ Both DEA and FDA released this letter on Aug. 1, 2023. It
is available at: https://www.dea.gov/sites/default/files/2023-08/DEA%20and%20FDA%20Issue%20Joint%20Letter%20to%20the%20Public.pdf.
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DEA commissioned two reports by IQVIA \14\ in order to understand
the demographic shifts impacting the prescribing of schedule II
stimulants. The reports provided valuable insights. Chief among those
insights was the observed increase in prescriptions dispensed for
mixed-salt amphetamine products to adults between the ages of 31-40
years, particularly women, and older patients (71-80 years old),
particularly during the COVID-19 pandemic (i.e. 2020 and 2021). In
contrast, during 2022, dispensed prescriptions for products containing
methylphenidate HCl and dexmethylphenidate HCl had a higher annual
increase in 2022 (than in 2021) as compared to mixed-salt amphetamine
products which may be indicative of product switching from amphetamine
to methylphenidate and dexmethylphendiate. Neither DEA nor FDA
anticipated these changes.
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\14\ Both reports are available at: https://www.deadiversion.usdoj.gov/drug_chem_info/stimulants/.
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In addition to these demographic shifts in prescribing, DEA also
evaluated inventory, manufacturing, and sales data submitted by
manufacturers through ARCOS and through reports submitted to DEA's
Quota Management System. That analysis revealed that dosage
manufacturers of amphetamine did not utilize the full extent of their
authorized quotas. DEA authorized amphetamine medication dosage form
manufacturers across the entire market to purchase and use 38,418
kilograms of amphetamine but those manufacturers initially \15\
reported the purchase of only 31,539 kg. Of that quantity, dosage
manufacturers only shipped 26,953 kg of amphetamine medications.
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\15\ In July 2023, several manufacturers who--according to their
reporting to DEA--had failed to use their full amphetamine
procurement quotas in 2022 received correspondence from DEA and FDA
asking them to confirm that they would use their full 2023
procurement quotas. Upon receiving that correspondence--
approximately seven months after the close of calendar year 2022--
one such manufacturer then revised its 2022 reporting to DEA to
reflect that it had, in fact, used nearly all of its 2022
amphetamine procurement quota.
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This ongoing work has led DEA to conclude that changes to its
regulations likely will be useful in developing more precise quotas
that will provide for the estimated medical, scientific, research, and
industrial needs of the United States, for lawful export requirements,
and for the establishment and maintenance of reserve stocks, while also
reducing opportunities for diversion. For instance, DEA believes that
changes to reporting requirements are necessary to improve both the
type of data collected and the timeliness of that data, allowing DEA to
be more nimble in its administration of the quota program. Future
regulatory changes may seek to address the lack of real-time inventory
and sales data accessible to DEA, the lack of information on production
lead times, and issues of timeliness in ARCOS reporting, by
considering, for example, requiring manufacturers to provide
anticipated production timelines and monthly ARCOS reporting. DEA is
not seeking comments on these concepts through this notice, but will
publish detailed proposals for comment in the future.
DEA also will seek additional information that will assist the
agency to more accurately forecast export requirements, especially for
those substances that are not controlled internationally.\16\ DEA
understands that manufacturers have contractual obligations that
dictate business decisions regarding the quantities of finished dosage
forms they will produce under a single DEA-issued quota, which applies
to products manufactured with an active ingredient, whether for
domestic or foreign markets. DEA also is exploring the purchase of
third-party data to improve its understanding of the dynamic changes in
foreign markets. Building off the recently issued quota management
rule,\17\ DEA also intends to add new subcategories to individual
manufacturing quotas and procurement quotas, to distinguish between
domestic requirements and export requirements.
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\16\ While amphetamine and methylphenidate are currently
recognized as schedule II controlled substances under the Convention
on Psychotropic Substances of 1971, lisdexamfetamine is not.
Additional details may be found at: https://www.incb.org/incb/en/psychotropics/1971_convention.html.
\17\ Management of Quotas for Controlled Substances and List I
Chemicals, 88 FR 60117 (Aug. 31, 2023) (effective Nov. 29, 2023).
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DEA also is considering methods by which it might increase
transparency in its quota setting process. Future regulatory proposals
may define additional steps, including such concepts as public
notification and an opportunity for public input when prescribing rates
for controlled substances deviate substantially from FDA's estimate of
future use. Furthermore, DEA is considering regulatory changes which
will authorize it to reduce a manufacturer's individual manufacturing
or procurement quota in order to apportion it to another manufacturer.
As with the regulatory changes mentioned above, DEA will welcome
comment on detailed proposals in the future, and is not requesting
comment on these general concepts in this notice.
The abovementioned regulatory changes will take time. In the
meantime, for the 2024 quota year, DEA intends to allocate procurement
quotas to DEA-registered manufacturers of schedule II controlled
substances on a quarterly basis. In order to address domestic drug
shortages of controlled substances, procurement quota allocations for
schedule II controlled substances will be divided between quantities
authorized for domestic sales and quantities authorized for export
sales. DEA will be sending a letter to each manufacturer with
instructions on the data that will be necessary to allow DEA to process
subsequent quarterly procurement quota allocations. DEA may publish or
post how many companies have been allocated quota in
[[Page 75318]]
a given calendar year, and how many of those companies have utilized
their allocated quota. Further, DEA may publish or post the names of
the companies that have been allocated quota.
The Administrator, therefore, proposes to establish the 2024 APQ
for certain schedule I and II controlled substances and AAN for the
list I chemicals ephedrine, pseudoephedrine, and phenylpropanolamine,
expressed in grams of anhydrous acid or base, as follows:
------------------------------------------------------------------------
Proposed 2024
quotas
Basic class ---------------
(g)
------------------------------------------------------------------------
Schedule I
------------------------------------------------------------------------
-[1-(2-Thienyl)cyclohexyl]pyrrolidine................... 20
1-(1-Phenylcyclohexyl)pyrrolidine....................... 30
1-(2-Phenylethyl)-4-phenyl-4-acetoxypiperidine.......... 10
1-(5-Fluoropentyl)-3-(1-naphthoyl)indole (AM2201)....... 30
1-(5-Fluoropentyl)-3-(2-iodobenzoyl)indole (AM694)...... 30
1-[1-(2-Thienyl)cyclohexyl]piperidine................... 15
2'-fluoro 2-fluorofentanyl.............................. 30
1-Benzylpiperazine...................................... 25
1-Methyl-4-phenyl-4-propionoxypiperidine................ 10
2-(2,5-Dimethoxy-4-ethylphenyl)ethanamine (2C-E)........ 30
2-(2,5-Dimethoxy-4-methylphenyl)ethanamine (2C-D)....... 30
2-(2,5-Dimethoxy-4-nitro-phenyl)ethanamine (2C-N)....... 30
2-(2,5-Dimethoxy-4-n-propylphenyl)ethanamine (2C-P)..... 30
2-(2,5-Dimethoxyphenyl)ethanamine (2C-H)................ 100
2-(4-Bromo-2,5-dimethoxyphenyl)-N-(2- 30
methoxybenzyl)ethanamine (25B-NBOMe; 2C-B-NBOMe; 25B;
Cimbi-36)..............................................
2-(4-Chloro-2,5-dimethoxyphenyl)ethanamine (2C-C)....... 30
2-(4-Chloro-2,5-dimethoxyphenyl)-N-(2- 25
methoxybenzyl)ethanamine (25C-NBOMe; 2C-C-NBOMe; 25C;
Cimbi-82)..............................................
2-(4-Iodo-2,5-dimethoxyphenyl)ethanamine (2C-I)......... 30
2-(4-Iodo-2,5-dimethoxyphenyl)-N-(2- 30
methoxybenzyl)ethanamine (25I-NBOMe; 2C-I-NBOMe; 25I;
Cimbi-5)...............................................
2,5-Dimethoxy-4-ethylamphetamine (DOET)................. 25
2,5-Dimethoxy-4-n-propylthiophenethylamine.............. 25
2,5-Dimethoxyamphetamine................................ 25
2-[4-(Ethylthio)-2,5-dimethoxyphenyl]ethanamine (2C-T-2) 30
2-[4-(Isopropylthio)-2,5-dimethoxyphenyl]ethanamine (2C- 30
T-4)...................................................
3,4,5-Trimethoxyamphetamine............................. 30
3,4-Methylenedioxyamphetamine (MDA)..................... 12,000
3,4-Methylenedioxymethamphetamine (MDMA)................ 12,000
3,4-Methylenedioxy-N-ethylamphetamine (MDEA)............ 40
3,4-Methylenedioxy-N-methylcathinone (methylone)........ 5,200
3,4-Methylenedioxypyrovalerone (MDPV)................... 35
3-FMC; 3-Fluoro-N-methylcathinone....................... 25
3-Methylfentanyl........................................ 30
3-Methylthiofentanyl.................................... 30
4,4'-Dimethylaminorex................................... 30
4-Bromo-2,5-dimethoxyamphetamine (DOB).................. 30
4-Bromo-2,5-dimethoxyphenethylamine (2-CB).............. 5,100
4-Chloro-alpha-pyrrolidinovalerophenone (4-chloro-alpha- 25
PVP)...................................................
4-CN-Cumyl-Butinaca..................................... 25
4-Fluoroisobutyryl fentanyl............................. 30
4F-MDMB-BINACA.......................................... 30
4-FMC; Flephedrone...................................... 25
4-MEC; 4-Methyl-N-ethylcathinone........................ 25
4-Methoxyamphetamine.................................... 150
4-Methyl-2,5-dimethoxyamphetamine (DOM)................. 25
4-Methylaminorex........................................ 25
4-Methyl-N-methylcathinone (mephedrone)................. 45
4-Methyl-alpha-ethylaminopentiophenone (4-MEAP)......... 25
4-Methyl-alpha-pyrrolidinohexiophenone (MPHP)........... 25
4'-Methyl acetyl fentanyl............................... 30
4-Methyl-[alpha]-pyrrolidinopropiophenone (4-MePPP)..... 25
5-(1,1-Dimethylheptyl)-2-[(1R,3S)-3-hydroxycyclohexyl]- 50
phenol.................................................
5-(1,1-Dimethyloctyl)-2-[(1R,3S)-3-hydroxycyclohexyl]- 40
phenol (cannabicyclohexanol or CP-47,497 C8-homolog)...
5F-AB-PINACA; (1-Amino-3-methyl-1-oxobutan-2-yl)-1-(5- 25
fluoropentyl)-1H-indazole-3-carboxamide................
5F-ADB; 5F-MDMB-PINACA (methyl 2-(1-(5-fluoropentyl)-1H- 25
indazole-3-carboxamido)-3,3-dimethylbutanoate).........
5F-CUMYL-P7AICA; 1-(5-Fluoropentyl)-N-(2-phenylpropan-2- 25
yl)-1H-pyrrolo[2,3-b]pyridine-3carboximide.............
5F-CUMYL-PINACA......................................... 25
5F-EDMB-PINACA.......................................... 25
5F-MDMB-PICA............................................ 25
5F-AMB (methyl 2-(1-(5-fluoropentyl)-1H-indazole-3- 25
carboxamido)-3-methylbutanoate)........................
5F-APINACA; 5F-AKB48 (N-(adamantan-1-yl)-1-(5- 25
fluoropentyl)-1H-indazole-3-carboxamide)...............
5-Fluoro-PB-22; 5F-PB-22................................ 25
5-Fluoro-UR144, XLR11 ([1-(5-fluoro-pentyl)-1Hindol-3- 25
yl](2,2,3,3-tetramethylcyclopropyl)methanone...........
5-Methoxy-3,4-methylenedioxyamphetamine................. 25
[[Page 75319]]
5-Methoxy-N,N-diisopropyltryptamine..................... 25
5-Methoxy-N,N-dimethyltryptamine........................ 11,000
AB-CHMINACA............................................. 30
AB-FUBINACA............................................. 50
AB-PINACA............................................... 30
ADB-FUBINACA (N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1- 30
(4-fluorobenzyl)-1H-indazole-3-carboxamide)............
Acetorphine............................................. 25
Acetyl Fentanyl......................................... 100
Acetyl-alpha-methylfentanyl............................. 30
Acetyldihydrocodeine.................................... 30
Acetylmethadol.......................................... 25
Acryl Fentanyl.......................................... 25
ADB-PINACA (N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1- 50
pentyl-1H-indazole-3-carboxamide)......................
AH-7921................................................. 30
All other tetrahydrocannabinol.......................... 790,010
Allylprodine............................................ 25
Alphacetylmethadol...................................... 25
alpha-Ethyltryptamine................................... 25
Alphameprodine.......................................... 25
Alphamethadol........................................... 25
alpha-Methylfentanyl.................................... 30
alpha-Methylthiofentanyl................................ 30
alpha-Methyltryptamine (AMT)............................ 25
alpha-Pyrrolidinobutiophenone ([alpha]-PBP)............. 25
alpha-pyrrolidinoheptaphenone (PV8)..................... 25
alpha-pyrrolidinohexabophenone (alpha-PHP).............. 25
alpha-Pyrrolidinopentiophenone ([alpha]-PVP)............ 25
Amineptine.............................................. 30
Aminorex................................................ 25
Anileridine............................................. 20
APINCA, AKB48 (N-(1-adamantyl)-1-pentyl-1H-indazole-3- 25
carboxamide)...........................................
Benzethidine............................................ 25
Benzylmorphine.......................................... 30
Betacetylmethadol....................................... 25
beta-Hydroxy-3-methylfentanyl........................... 30
beta-Hydroxyfentanyl.................................... 30
beta-Hydroxythiofentanyl................................ 30
beta-Methyl fentanyl.................................... 30
beta'-Phenyl fentanyl................................... 30
Betameprodine........................................... 25
Betamethadol............................................ 4
Betaprodine............................................. 25
Brorphine............................................... 30
Bufotenine.............................................. 15
Butonitazene............................................ 30
Butylone................................................ 25
Butyryl fentanyl........................................ 30
Cathinone............................................... 40
Clonitazene............................................. 25
Codeine methylbromide................................... 30
Codeine-N-oxide......................................... 192
Crotonyl Fentanyl....................................... 25
Cyclopentyl Fentanyl.................................... 30
Cyclopropyl Fentanyl.................................... 20
Cyprenorphine........................................... 25
d-9-THC................................................. 900,610
Desomorphine............................................ 25
Dextromoramide.......................................... 25
Diapromide.............................................. 20
Diethylthiambutene...................................... 20
Diethyltryptamine....................................... 25
Difenoxin............................................... 9,300
Dihydromorphine......................................... 639,954
Dimenoxadol............................................. 25
Dimepheptanol........................................... 25
Dimethylthiambutene..................................... 20
Dimethyltryptamine...................................... 3,000
Dioxyaphetyl butyrate................................... 25
Dipipanone.............................................. 25
Drotebanol.............................................. 25
Ethylmethylthiambutene.................................. 25
[[Page 75320]]
Ethylone................................................ 25
Etodesnitazene.......................................... 30
Etonitazene............................................. 25
Etorphine............................................... 30
Etoxeridine............................................. 25
Eutylone................................................ 30
Fenethylline............................................ 30
Fentanyl carbamate...................................... 30
Fentanyl related substances............................. 600
Flunitazene............................................. 30
FUB-144................................................. 25
FUB-AKB48............................................... 25
Fub-AMB, MMB-Fubinaca, AMB-Fubinaca..................... 25
Furanyl fentanyl........................................ 30
Furethidine............................................. 25
gamma-Hydroxybutyric acid............................... 29,417,000
Heroin.................................................. 150
Hydromorphinol.......................................... 40
Hydroxypethidine........................................ 25
Ibogaine................................................ 150
Isobutyryl Fentanyl..................................... 25
Isotonitazine........................................... 25
JWH-018 and AM678 (1-Pentyl-3-(1-naphthoyl)indole)...... 35
JWH-019 (1-Hexyl-3-(1-naphthoyl)indole)................. 45
JWH-073 (1-Butyl-3-(1-naphthoyl)indole)................. 45
JWH-081 (1-Pentyl-3-[1-(4-methoxynaphthoyl)]indole)..... 30
JWH-122 (1-Pentyl-3-(4-methyl-1-naphthoyl)indole)....... 30
JWH-200 (1-[2-(4-Morpholinyl)ethyl]-3-(1- 35
naphthoyl)indole)......................................
JWH-203 (1-Pentyl-3-(2-chlorophenylacetyl)indole)....... 30
JWH-250 (1-Pentyl-3-(2-methoxyphenylacetyl)indole)...... 30
JWH-398 (1-Pentyl-3-(4-chloro-1-naphthoyl)indole)....... 30
Ketobemidone............................................ 30
Levomoramide............................................ 25
Levophenyacylmorphan.................................... 25
Lysergic acid diethylamide (LSD)........................ 1,200
MAB-CHMINACA; ADB-CHMINACA (N-(1-amino-3,3-dimethyl-1- 30
oxobutan-2-yl)-1-(cyclohexylmethyl)-1H-indazole-3-
carboxamide)...........................................
MDMB-CHMICA; MMB-CHMINACA(methyl 2-(1-(cyclohexylmethyl)- 30
1H-indole-3-carboxamido)-3,3-dimethylbutanoate)........
MDMB-FUBINACA (methyl 2-(1-(4-fluorobenzyl)-1H-indazole- 30
3-carboxamido)-3,3-dimethylbutanoate)..................
MMB-CHMICA-(AMB-CHIMCA); Methyl-2-(1-(cyclohexylmethyl)- 25
1H-indole-3-carboxamido)-3-methylbutanoate.............
Mesocarb................................................ 30
Metodesnitazene......................................... 30
Metonitazene............................................ 30
Marijuana............................................... 6,675,000
Marijuana extract....................................... 1,000,000
Mecloqualone............................................ 30
Mescaline............................................... 1,200
Methaqualone............................................ 60
Methcathinone........................................... 25
Methiopropamine......................................... 30
Methoxetamine........................................... 30
Methoxyacetyl fentanyl.................................. 30
Methyldesorphine........................................ 5
Methyldihydromorphine................................... 25
Morpheridine............................................ 25
Morphine methylbromide.................................. 5
Morphine methylsulfonate................................ 5
Morphine-N-oxide........................................ 150
MT-45................................................... 30
Myrophine............................................... 25
NM2201: Naphthalen-1-yl 1-(5-fluorpentyl)-1H-indole-3- 25
carboxylate............................................
N,N-Dimethylamphetamine................................. 25
Naphyrone............................................... 25
N-Ethyl-1-phenylcyclohexylamine......................... 25
N-Ethyl-3-piperidyl benzilate........................... 10
N-Ethylamphetamine...................................... 24
N-Ethylhexedrone........................................ 25
N-Ethylpentylone, ephylone.............................. 30
N-Hydroxy-3,4-methylenedioxyamphetamine................. 24
Nicocodeine............................................. 25
Nicomorphine............................................ 25
[[Page 75321]]
N-methyl-3-piperidyl benzilate.......................... 30
N-Pyrrolidino Etonitazene............................... 30
Noracymethadol.......................................... 25
Norlevorphanol.......................................... 2,550
Normethadone............................................ 25
Normorphine............................................. 40
Norpipanone............................................. 25
Ocfentanil.............................................. 25
ortho-Fluoroacryl fentanyl.............................. 30
ortho-Fluorobutyryl fentanyl............................ 30
Ortho-Fluorofentanyl,2-Fluorofentanyl................... 30
ortho-Fluoroisobutyryl fentanyl......................... 30
ortho-Methyl acetylfentanyl............................. 30
ortho-Methyl methoxyacetyl fentanyl..................... 30
Para-Chlorisobutyrl fentanyl............................ 30
Para-flourobutyryl fentanyl............................. 25
Para-fluorofentanyl..................................... 25
para-Fluoro furanyl fentanyl............................ 30
Para-Methoxybutyrl fentanyl............................. 30
Para-methoxymethamphetamine............................. 30
para-Methylfentanyl..................................... 30
Parahexyl............................................... 5
PB-22; QUPIC............................................ 20
Pentedrone.............................................. 25
Pentylone............................................... 25
Phenadoxone............................................. 25
Phenampromide........................................... 25
Phenomorphan............................................ 25
Phenoperidine........................................... 25
Phenyl fentanyl......................................... 30
Pholcodine.............................................. 5
Piritramide............................................. 25
Proheptazine............................................ 25
Properidine............................................. 25
Propiram................................................ 25
Protonitazene........................................... 30
Psilocybin.............................................. 15,000
Psilocyn................................................ 24,000
Racemoramide............................................ 25
SR-18 and RCS-8 (1-Cyclohexylethyl-3-(2- 45
methoxyphenylacetyl)indole)............................
SR-19 and RCS-4 (1-Pentyl-3-[(4-methoxy)-benzoyl]indole) 30
Tetrahydrofuranyl fentanyl.............................. 15
Thebacon................................................ 25
Thiafentanil............................................ 25
Thiofentanyl............................................ 25
Thiofuranyl fentanyl.................................... 30
THJ-2201 ( [1-(5-fluoropentyl)-1H-indazol-3- 30
yl](naphthalen-1-yl)methanone).........................
Tilidine................................................ 25
Trimeperidine........................................... 25
UR-144 (1-pentyl-1H-indol-3-yl)(2,2,3,3- 25
tetramethylcyclopropyl)methanone.......................
U-47700................................................. 30
Valeryl fentanyl........................................ 25
Zipeprol................................................ 30
------------------------------------------------------------------------
Schedule II
------------------------------------------------------------------------
1-Phenylcyclohexylamine................................. 15
1-Piperidinocyclohexanecarbonitrile..................... 25
4-Anilino-N-phenethyl-4-piperidine (ANPP)............... 866,746
Alfentanil.............................................. 5,000
Alphaprodine............................................ 25
Amobarbital............................................. 20,100
Bezitramide............................................. 25
Carfentanil............................................. 20
Cocaine................................................. 60,492
Codeine (for conversion)................................ 942,452
Codeine (for sale)...................................... 19,262,957
d-amphetamine (for sale)................................ 21,200,000
d,l-amphetamine......................................... 21,200,000
d-amphetamine (for conversion).......................... 20,000,000
Dexmethylphenidate (for sale)........................... 6,200,000
[[Page 75322]]
Dexmethylphenidate (for conversion)..................... 4,200,000
Dextropropoxyphene...................................... 35
Dihydrocodeine.......................................... 115,227
Dihydroetorphine........................................ 25
Diphenoxylate (for conversion).......................... 14,100
Diphenoxylate (for sale)................................ 770,800
Ecgonine................................................ 60,492
Ethylmorphine........................................... 30
Etorphine hydrochloride................................. 32
Fentanyl................................................ 676,062
Glutethimide............................................ 25
Hydrocodone (for conversion)............................ 1,250
Hydrocodone (for sale).................................. 27,143,545
Hydromorphone........................................... 1,951,801
Isomethadone............................................ 30
L-amphetamine........................................... 30
Levo-alphacetylmethadol (LAAM).......................... 25
Levomethorphan.......................................... 30
Levorphanol............................................. 20,000
Lisdexamfetamine........................................ 26,500,000
Meperidine.............................................. 681,184
Meperidine Intermediate-A............................... 30
Meperidine Intermediate-B............................... 30
Meperidine Intermediate-C............................... 30
Metazocine.............................................. 15
Methadone (for sale).................................... 25,619,700
Methadone Intermediate.................................. 27,673,600
d,l-Methamphetamine..................................... 150
d-methamphetamine (for conversion)...................... 485,020
d-methamphetamine (for sale)............................ 47,000
l-methamphetamine....................................... 587,229
Methylphenidate (for sale).............................. 53,283,000
Methylphenidate (for conversion)........................ 19,975,468
Metopon................................................. 25
Moramide-intermediate................................... 25
Morphine (for conversion)............................... 2,393,200
Morphine (for sale)..................................... 20,805,957
Nabilone................................................ 62,000
Norfentanyl............................................. 25
Noroxymorphone (for conversion)......................... 22,044,741
Noroxymorphone (for sale)............................... 1,000
Oliceridine............................................. 25,100
Opium (powder).......................................... 250,000
Opium (tincture)........................................ 530,837
Oripavine............................................... 33,010,750
Oxycodone (for conversion).............................. 437,827
Oxycodone (for sale).................................... 53,658,226
Oxymorphone (for conversion)............................ 28,204,371
Oxymorphone (for sale).................................. 464,464
Pentobarbital........................................... 33,843,337
Phenazocine............................................. 25
Phencyclidine........................................... 35
Phenmetrazine........................................... 25
Phenylacetone........................................... 100
Piminodine.............................................. 25
Racemethorphan.......................................... 5
Racemorphan............................................. 5
Remifentanil............................................ 3,000
Secobarbital............................................ 172,100
Sufentanil.............................................. 4,000
Tapentadol.............................................. 10,390,226
Thebaine................................................ 57,137,944
------------------------------------------------------------------------
List I Chemicals
------------------------------------------------------------------------
Ephedrine (for conversion).............................. 41,100
Ephedrine (for sale).................................... 3,933,336
Phenylpropanolamine (for conversion).................... 14,878,320
Phenylpropanolamine (for sale).......................... 7,990,000
Pseudoephedrine (for conversion)........................ 1,000
Pseudoephedrine (for sale).............................. 170,360,314
------------------------------------------------------------------------
[[Page 75323]]
The Administrator further proposes that aggregate production quotas
for all other schedule I and II controlled substances included in 21
CFR 1308.11 and 1308.12 remain at zero.
These proposed 2024 quotas reflect the quantities that DEA believes
are necessary to meet the estimated medical, scientific, research, and
industrial needs of the United States, lawful export requirements; and
the establishment and maintenance of reserve stocks. DEA remains
committed to conducting continuous surveillance on the supply of
schedule II controlled substances and list I chemicals necessary to
treat patients with COVID-19, and, pursuant to her authority, the
Administrator will move swiftly and decisively to increase any 2024 APQ
that she determines is necessary to address an unforeseen increase in
demand, should that occur.
In accordance with 21 CFR 1303.13 and 1315.13, upon consideration
of the relevant factors, the Administrator may adjust the 2024 APQ and
AAN as needed.
Conclusion
After consideration of any comments or objections, or after a
hearing, if one is held, the Administrator will issue and publish in
the Federal Register a final order establishing the 2024 APQ for
controlled substances in schedules I and II and establishing an AAN for
the list I chemicals ephedrine, pseudoephedrine, and
phenylpropanolamine, as directed by 21 CFR 1303.11(c) and 1315.11(f).
Signing Authority
This document of the Drug Enforcement Administration was signed on
October 30, 2023, by Administrator Anne Milgram. That document with the
original signature and date is maintained by DEA. For administrative
purposes only, and in compliance with requirements of the Office of the
Federal Register, the undersigned DEA Federal Register Liaison Officer
has been authorized to sign and submit the document in electronic
format for publication, as an official document of DEA. This
administrative process in no way alters the legal effect of this
document upon publication in the Federal Register.
Scott Brinks,
Federal Register Liaison Officer, Drug Enforcement Administration.
[FR Doc. 2023-24282 Filed 11-1-23; 8:45 am]
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