Controlled Substances Ordering System

Under the authority of the Controlled Substances Act of

1970, the Drug Enforcement Administration (DEA), Office
of Diversion Control (OD) regulates the manufacture and
distribution of controlled substances in the United States.
This regulatory control is designed to prevent the diversion
of legitimate pharmaceutical drugs into illegal channels
and to ensure that there is a sufficient supply for legitimate
medical uses. The DEA’s regulations currently allow for the
electronic transmission of controlled substance orders for
Schedule II substances as long as the supporting DEA 222
Form follows the electronic order. The DEA is working to
modify its regulations to allow for a secure electronic
transmission of controlled substance orders without the
supporting 222 Form. The Controlled Substances Ordering
System (CSOS) is expected to bring numerous benefits to
the manufacturing, distribution, and pharmacy community.
These benefits include:

- The number of ordering errors would be less.

- The customer could include more line items on a

single order.

- With faster ordering there would be less

consolidating of orders by pharmacists, and orders
could be placed more frequently for fewer items.

- With faster ordering there would be less reason to

stockpile product and less waiting to fill up an order
form.

- Less product could be kept on the shelf and smaller

orders could be placed more frequently.

The transaction volume from pharmacies to distributors is

estimated at over 800,000 per year. By industry’s own
accounts, incorporating an electronic ordering system
would result in a substantial cost savings.

Responding to Industry’s needs

The typical turnaround time for an order utilizing the DEA
222 form is 1 to 3 days from the time the order is submitted
until it is delivered. The factor that influences the
turnaround time is the manner in which the form is
transported from customer to supplier.

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 - Orders that are given directly to the distributor’s
drivers, or orders that are FedEx’ed or couriered are
obtained more quickly.

- Orders that are placed in the regular mail tend to take

longer- from 3 to 7 days.

Factors that significantly contribute to slower turnaround

times include:

- US Mail

- Getting the paper document from point A to B.

- Improperly filled out 222 Form

- Weather

- Quotas and Lack of Inventory

Error rates with the paper DEA 222 form are critical in the
processing time for a controlled substance order. The
following contribute to the error rate:

- Corporate name changes, address changes due to

Post Office redistricting, road construction changes
that change addresses, mergers and acquisitions.

- Human errors such as National Drug Code (NDC)

numbers that are transposed, forgetting to sign the
DEA 222 Form and wrong number of line items
indicated.

Factors that lower the error rates are:

- Corporate policy that only allows experienced

employees to transact DEA 222 Forms.

- In-store training provided to those utilizing DEA 222

Forms.

- Training manuals and cheat sheets.

- Fear of fines from DEA audits.

An Allowance Not a Mandate

The DEA understands that businesses must weigh the
advantages of any new technology against the
implementation costs, and understand the expected return

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 on investment. Since some DEA registrants may not wish
to take advantage of the new regulations, the DEA will
leave current regulations and current processes in place.
The 222 paper form process will still be available. The DEA
will not force registrants to use CSOS. Adoption of CSOS
standards will be the only allowance for the electronic
transmission of Schedule II controlled substance orders
from distributors to manufacturers and from pharmacies to
distributors.

How will electronic ordering of controlled substances be

secured?
To guarantee a similar degree of security as found in the
paper 222 system, the DEA will establish an electronic
ordering system where Schedule II substance orders are
digitally signed using Public Key Infrastructure (PKI)
technology. This technology will bring to the process the
following advantages: (1) reduce the amount of paper in
the process (2) speed transaction times (3) lower costs per
transaction and (4) introduce security services into the
process. The following paragraphs explain the underlying
security technology that makes this possible.

What is a Digital Signature?

Frequently, the last business processes to be automated

are those that require a “wet signature.” In the electronic
world, PKI can replace the traditional approach with a more
robust method that delivers both message integrity and
nonrepudiation. The solution combines a “document
fingerprint” with public key cryptography. Public key
cryptography is an important tool used in creating a digital
signature.

Signing a document—First, the sender’s computer runs

the document through a complex algorithm to generate a
fixed-length message digest—the unique document
fingerprint. If even one letter in the document changes, the
fingerprint also changes. Now the sender can use their
private key to encrypt the digest. The encrypted digest,
called a “digital signature,” is then sent along with the
message.

Verifying a signature—Upon receiving the digitally

signed document, the recipient uses the sender’s public
key to decrypt the signature and obtain the original
message digest. If the signature can be decrypted with the
sender’s public key, then only the sender could have sent

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it. This provides the service of nonrepudiation. The
recipient then calculates a new message digest and
compares this with the one that has just been decrypted. If
they match, the document has not been changed. This
provides the service of message integrity. This process is
instantaneously and transparently performed by PKI-
enabled systems.

What is a Certification Authority?

A Certification Authority (CA) is an entity that issues digital

certificates to its trusted users. It also makes certificate
status information available to relying parties. In this
capacity, it acts as a credible and neutral trusted third
party. Users implicitly trust any information that is digitally
signed by the CA. The CA performs a number of important
duties, including:

• Enrollment. Before issuing a digital certificate, the CA

verifies the identity of the applicant to ensure that the
digital certificate is being “bound” to the correct individual
and not to an impostor. Depending on the intended
application, some CAs require in-person enrollment while
others may allow enrollment over the web. Such
procedures are defined in the Certificate Policy (CP).

• Revocation. Digital Certificates can be revoked for a

number of reasons including loss or compromise. The CA
lists these untrusted certificates on a Certificate
Revocation List (CRL) in the same way the credit card
companies once published lists of invalid credit cards. The
CRL is digitally signed by the CA and is valid for a
specified time period.

• Publishing certificates and CRLs. The CA publishes

public certificates and CRLs to a network directory. Think
of this as computerized white pages. Users are not
vulnerable if their certificates are published. The worst
thing that can happen is that someone would be able to
encrypt a message for the user.

What is a Digital Certificate?

By digitally signing the user’s public key, the CA trans-

forms a user’s public key into a form that other participants
can trust, namely a digital certificate. The X.509 standard
defines the information a certificate must contain, such as
the user’s name, the user’s public key, and the certificate’s
validity period.

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 The Need for a Certificate Policy

While technology provides the mechanism to solve the

security issues facing the electronic transmission of
controlled substance orders, policy ensures that the
technology is implemented correctly and managed
appropriately. The policy framework is as important as the
technology itself.

A certificate policy defines the level of assurance the PKI

provides. The assurance level results from many
operational decisions the CA has made, ranging from due
diligence in the enrollment process to how often CRLs will
be posted. All policies are not the same; the business
application guides the development of the policy. The
policy identifies the set of obligations the management and
subscriber communities must fulfill. For example:

Securing the private key-For true nonrepudiation,

(assurance that the order was sent from a registrant or the
registrant’s Power Of Attorney (POA) and no one else), the
registrant or POA must not share this private key with
anyone.

Accepting a signed order-Upon receipt of a digitally

signed order, relying parties must ensure that the digital
certificate used to digitally sign the order has not expired.
Relying parties must also verify that the digital certificate is
not on a CRL. If it is on the CRL, the order should be
rejected. Finally, the signature must be verified to ensure
that the document has not been modified. To ensure that
all of the above functions are performed every time,
computer systems can be programmed to perform these
functions automatically.

Elements of the CSOS Framework

The CSOS framework is being designed to provide trust
services to DEA registered manufacturers, distributors,
pharmacies, and other 222 users. The framework will
consist of commercially operated systems with integrated
PKI enabled software. The CSOS framework is made up of
the following elements: 1) Certification Authority (CA), 2)
Directory for public access, 3) CSOS-PKI enabled
Electronic Ordering Systems, 4) CSOS participating, DEA
registered manufacturers, distributors, retail pharmacies,
and other 222 users.

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CSOS Certification Authority
The CSOS framework was developed after carefully
considering a number of PKI-architecture alternatives. The
architectures were evaluated with respect to a number of
factors including regulatory enforceability.

The CA, Directory, and supporting infrastructure are

designed to function as an alternative system that is legally
equivalent to, but does not supplant, the 222 paper form
for Schedule II substances.

While the DEA has the authority to take action against

registrants who fail to follow DEA regulations, it was
unclear how DEA would be able to enforce certificate
policy if a commercial CA’s certificate was utilized by DEA
registrants/POA’s. In the event that a registrant/POA
operates in an improper manner—inconsistent with the
DEA’s CSOS Certificate Policy—the DEA desires the
ability to revoke the CSOS certificate of that
registrant/POA. By operating its own CA, the DEA would
have the ability to control all functions and actions of the
CA. While such a step would be drastic, it would only
occur after discussions with the DEA Program
Management Authority (PMA) or after some form of legal
or administrative action.

CA CSOS PKI Framework

Directory

Shadowed Shadowed
Directory Shadowed Directory
Directory

Certificate
status
checking

Enrollment Enrollment
Digital Digital
certificate certificate
issuance issuance

s a
u r Electronic Ordering
b c
m h System
i i
t v Digitally signed
e Controlled Substances
Participating Order
Pharmacy Participating
Distributor

Exhibit 1

The DEA intends to establish a CSOS Certification

Authority as shown in Exhibit 1. Under this framework, the

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 CA will be operated in accordance with the DEA’s
Certificate Policy and has the authority to issue and revoke
CSOS Digital Certificates to DEA registrants and POA’s.

Responsibilities of CSOS Certification Authority

− Comply with the DEA’s CSOS Certificate Policy-

The DEA will define the CSOS Certificate Policy (CP).
The CP will set strict standards and obligations that
must be met by the CSOS Certification Authority.

− Issue CSOS Certificates to DEA registrants-

Registrants and qualified POA’s will be able to apply for
a CSOS certificate either in-person or on-line. It is
anticipated in the case of on-line enrollment, the
registrant/POA would first have to submit a signed copy
of some type of a DEA application form along with proof
of DEA registration.

− Publish up-to-date Certificate Status Information –

The CA must publish a CRL on a regular basis as
defined in the CSOS CP. The CRL identifies the CSOS
digital certificates that have been revoked by the CA.

− Maintain a CRL Archive- The CA will be required to

maintain an archive of all CRLs published.

− Perform an Annual Audit- Participating industry

ordering systems will be required to submit to a yearly
third-party audit indicating that they are operating in
compliance with DEA standards.

Electronic Ordering System Applications

Today, there are numerous industry systems used by

manufacturers and distributors for transmission of their
customer’s orders electronically. Under the DEA’s current
regulations, these systems are prohibited from
electronically transmitting Schedule II controlled substance
orders without the order also being submitted on the DEA
222 Form. The DEA anticipates that once its revised
regulations are in place, industry will be able to PKI-enable
their ordering systems to support digitally signed electronic
orders for controlled substances to comply with the newly
established standards.

Industry Obligations

Electronic ordering systems will be expected to provide

services between manufacturers, distributors, and

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 customers. Depending on the functionality provided by the
ordering system, the following obligations would be
pertinent to the system.

Support CSOS Digital Signatures—The system must

provide the customer with the ability to digitally sign all
electronically transmitted controlled substance orders
using the registrant’s or POA’s CSOS private key. The
system should automatically prompt the customer for a
digital signature prior to submission of a controlled
substance order. The system must transmit the registrant’s
or POA’s CSOS public key and digital certificate along with
the controlled substance order.

Support Validation of CSOS Digital Signatures— The

system must provide the supplier with the ability to validate
a digitally signed controlled substance order. The system
should verify that the order has been digitally signed, that
the user who signed the order is not on a CRL, and that
the digital signature is valid which indicates that the order
has not been altered. Once validation has been
successfully checked, the system must archive the original
order without alteration, the registrants or POA’s CSOS
public key and digital certificate, and the digital signature
along with the controlled substance order.

Perform Audit of PKI-Enabled Ordering Systems—

Suppliers who PKI-enable their ordering systems will be
required to perform a yearly third-party audit of their
applications to ensure that the software correctly performs
the applicable obligations.

CSOS Participants

DEA registered manufacturers, distributors, pharmacies,

and other users of the 222 form for Schedule II substances
will be eligible to obtain CSOS digital certificates. CSOS
digital certificates will be valid for one year and will allow
the user to electronically transmit orders for schedule II
controlled substances and eventually for schedule II-V
controlled substances. Since the DEA registration-based
CSOS digital certificate is structured to certify the holder’s
registration status to the relying party for the ordering
transaction, registrants and the authorized POA’s of the
registrants will be allowed to obtain a DEA CSOS digital
certificate according to what is required by the CONOPS,
Certificate Policy, and Certificate Practice Statement policy
documents.

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As relying parties to the electronic ordering of controlled
substances transaction, pharmacies, hospitals and other
registrants who wish to participate in the CSOS program
will receive CSOS certificates. The electronic ordering
system they use will be required to be CSOS-compliant.
This means that the software must perform the CSOS-
defined relying party obligations—identified below—prior to
submitting an electronic order for controlled substances.

Participant Customer Obligations

The following bullets identify some of the CSOS

participants’ obligations.

− Apply for a CSOS Digital Certificate—Before a

participant can begin electronially submitting controlled
substance orders, they must first submit a properly
documented application to the CSOS CA. DEA
registrants/POA’s will be permitted to order controlled
substances electronically only after the application has
been approved and the CA has issued a digital
certificate to the registrant/POA.

− Safeguard the Private Key—The participant is

obligated to protect the private key on a smartcard or
other physical device under the sole control of the
participant.

− Notify CA in event of lost or stolen private key—

CSOS participants are obligated to notify the CSOS
Certification Authority within 24 hours of the loss of the
private key.

Supplier Obligations

The following bullets identify the key CSOS supplier

obligations that must be performed prior to fulfilling an
electronically transmitted order for controlled substances.
These obligations must be performed for every submitted
order. The steps of verification and validation will be
performed by the PKI enabled applications instantaneously
and will be transparent to the user.

− Order Signature Verification—Verify that the

electronic order has not been altered or that it is not a
forgery. The supplier must reject fraudulent orders and
orders that have been tampered with.

− Validate Customer’s Status—Check the status of the

customer’s CSOS digital certificate to ensure that the
signature comes from a DEA registrant or POA, verify

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 that the registrants/POA’s CSOS digital certificate is not
on the CRL, and verify that the registrant/POA is
authorized to order the appropriate schedule of
controlled substances. The supplier must reject the
order if the customer’s digital certificate has been
revoked, or if the customer’s digital signature is not
valid.

− Maintain an Archive for 2 years—The supplier must

maintain an electronic archive of all orders received and
controlled substances shipped.

− Electronically Sign the Reporting Information—For

all valid CSOS orders, the supplier must electronically
sign the reporting information that is submitted to DEA
so that the supplier is bound to the act of fulfilling the
order.

− Submit required info to DEA — all Schedule II

information is required to be submitted upon completion
of the order.

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DEA’s Efforts to Date

− Gathering Security Requirements

Interviews were performed with a representative mix from

manufacturers, distributors, and pharmacies to identify
issues about the current paper 222 form and the proposed
electronic process for controlled substances. The results of
this effort are documented in the MADI PKI Certificate
Policy Requirements Analysis posted on the DEA’s web
site at http://www.deadiversion.usdoj.gov.

− Industry IT Infrastructure Review

DEA is sensitive to the significant investment that the

manufacturing, distributing, and pharmacy industry has
made in Information Technology. To ensure that any
electronic ordering system for controlled substances
framework is consistent with industry’s IT architectures and
configurations, extensive interviews with industry
representatives were conducted to identify how the
framework could be designed to minimize the impact on
industry while at the same time leveraging existing
infrastructure. The results of this effort are documented in
the MADI PKI Existing Network Infrastructure Analysis
posted on the DEA’s web site at
http://www.deadiversion.usdoj.gov.

Future DEA Efforts

Concept of Operations - From the outset, industry
opinions have been solicited on how a PKI framework
would operate. As a part of this process, DEA will be
provided with a Concept of Operations (CONOPS) which
will define a clear picture of the CSOS PKI framework and
how it will be designed and operated. The CONOPS
defines the mechanisms by which the following events
occur:

Design concepts -

Roles and Responsibilities of the PKI system –

System enrollment –

Auditing of PKI enabled systems –

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The results of this effort will be documented on the DEA’s
web site at http://www.deadiversion.usdoj.gov

PKI Product Review - DEA will be provided with a review

of PKI products which will describe the evaluation of COTS
PKI products which are currently available. The evaluation
is based upon products that exhibit the capabilities and
features needed to meet OD’s regulatory requirements.
The results of this effort will be documented on the DEA’s
web site at http://www.deadiversion.usdoj.gov.

PKI Design Plan -DEA will be provided with a

comprehensive design plan which will describe the
components, software, and structure necessary to support
a production PKI infrastructure. The results of this effort will
be documented on the DEA’s web site at
http://www.deadiversion.usdoj.gov.

PKI Implementation Plan -DEA will be provided with a

detailed plan for additional acquisitions, installation,
configuration, testing, certification, and end-user training
requirements. The results of this effort will be documented
on the DEA’s web site at
http://www.deadiversion.usdoj.gov.

Certification Practice Statement (CPS) -DEA will be

provided with the CPS which will describe specifically how
the policy objectives are to be achieved. The results of this
effort will be documented on the DEA’s web site at
http://www.deadiversion.usdoj.gov.

Certificate Policy -DEA will be provided with a policy

document which describes the level of security the CA will
function at. This document will have implications that the
users of the PKI system must face regarding whether or
not to trust certificates issued by the CSOS CA. The
results of this effort will be documented on the DEA’s web
site at http://www.deadiversion.usdoj.gov.

PKI Management Selection and Training Plan -DEA will

be provided with a description of the personnel
requirements for the POC and full production staff.
Included will be roles and responsibilities, training,
deployment, and specific training required. The results of
this effort will be documented on the DEA’s web site at
http://www.deadiversion.usdoj.gov.

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