What Happened

DEA revoked a Virginia physician's registration by final agency order published in the Federal Register on August 28, 2026, after the prescriber failed to respond to a December 2025 order to show cause and the underlying allegations were deemed admitted.

DEA had issued an order to show cause and immediate suspension of registration on December 10, 2025, finding that the physician's continued registration posed "an imminent danger to the public health or safety." The order proposed revocation on two independent grounds: that the physician lacked state authority to prescribe controlled substances in Virginia, and that continued registration was inconsistent with the public interest. The physician's registration had already expired on December 31, 2025, and no hearing was requested, so under 21 CFR 1301.43 the registrant was held in default and the factual allegations in the order to show cause were deemed admitted without a hearing.

According to those deemed-admitted allegations, between March and April 2025 the physician issued numerous concurrent prescriptions for an opioid and a benzodiazepine to two patients, and both patients died of acute intoxication caused by the combination prescribed. In each case, the physician prescribed oxycodone/acetaminophen and diazepam days apart, then directed the patient to take several tablets of each shortly before an outpatient procedure at which the physician also administered local lidocaine. Each patient developed respiratory distress in the office; the first patient died the same day, and the second died several days later. DEA's final order revoked the registration and denied any pending application to renew, modify, or obtain an additional registration, effective September 28, 2026.

What Went Wrong

Because this was a default action, the following describes allegations deemed admitted, not findings made after a hearing — but the pattern is one diversion and patient-safety programs should recognize:

  • Concurrent opioid-benzodiazepine prescribing without documented justification. Virginia regulation permits co-prescribing an opioid and a benzodiazepine only when extenuating circumstances exist and are documented in the medical record. The allegations state no such circumstances were documented for either patient.
  • No lowest-effective-dose prescribing and no risk mitigation. The allegations state the physician did not prescribe the opioid in the lowest effective dose and did not take steps to mitigate the known risk of combining an opioid and a benzodiazepine, such as prescribing or administering an opioid reversal agent — a step Virginia regulation requires when the two drug classes are co-prescribed.
  • No documented counseling or consideration of alternatives. The allegations state there was no meaningful consideration of non-opioid treatment and no counseling of either patient on the risks of the opioid, the benzodiazepine, or combining the two.
  • A default forfeited the physician's opportunity to contest the record. Failing to answer an order to show cause converts the agency's allegations into the operative facts of the case — there is no dispute of the underlying record once a default is entered.

How It Could Have Been Prevented

  • Follow state-specific rules for co-prescribing opioids and benzodiazepines, including documenting the extenuating circumstances required before combining the two drug classes.
  • Document consideration of non-opioid alternatives and risk counseling for every patient receiving an opioid, a benzodiazepine, or both, as part of the clinical record rather than relying on memory.
  • Prescribe or administer an opioid reversal agent whenever an opioid and a benzodiazepine are co-prescribed, consistent with state requirements designed to mitigate fatal overdose risk.
  • Build internal review processes that flag concurrent opioid-benzodiazepine prescribing patterns before a regulator does, particularly around procedures performed in an office setting without hospital-level monitoring.
  • Respond to any DEA order to show cause promptly and request a hearing; a default forfeits the ability to contest the agency's factual allegations before they become the basis for revocation.

Related Guidance

Sources