Maine’s congressional delegation called on the U.S. Drug Enforcement Administration to clarify a new registration category that has prompted local hospital groups to stop supplying critical drugs to around 140 EMS agencies.

In a letter Monday to DEA Administrator Terrance Cole, the state’s delegation said Maine’s healthcare system has experienced confusion and disruption since the DEA added the EMS registration category as the “final rule” of a federal statute, Protecting Patient Access to Emergency Medications Act, in February.

The registration category allows EMS agencies to administer controlled substances under their own registrations, rather than a hospital’s, as has been standard practice in Maine.

But because it was not clear that registration is optional, the delegation said, two of Maine’s biggest health systems are ending 140 medication agreements with EMS agencies. In turn, EMS chiefs across Maine are scrambling to get registered with the DEA against time and funding constraints.

Sens. Angus King and Susan Collins, and Reps. Chellie Pingree and Jared Golden called on the DEA to clarify the final rule.

“The conflicting interpretations of this rule have led our state’s largest hospital networks to abruptly terminate long-standing agreements held with local EMS providers for such medical supplies,” they wrote. “Therefore, swift clarification from the DEA is urgently needed not only to prevent exorbitant, unexpected costs from being forced onto Maine’s EMS agencies but also to preserve vital local partnerships.”

Without medication agreements, many agencies say they have no choice but to purchase expensive safes and storage equipment required for registration, or stop providing critical drugs like fentanyl and ketamine.

Northern Light Health has said it will end about 50 medication agreements, while MaineHealth said it would stop supplying controlled substances to roughly 90 emergency medical services agencies on July 14, causing outcry from dozens of EMS chiefs.

MaineHealth has since said that most of the affected EMS agencies are making progress toward compliance. The health system is “providing flexibilities in the timelines for DEA registration and medication” for those that did not meet the deadline.

A spokesperson for MaineGeneral Health, which has 24 medication agreements, said this week that the health system had not made a decision about medication agreements.

Redington-Fairview General Hospital in Skowhegan is not ending agreements, spokesperson Lori Paradis said.

“We intend to continue our current agreements with area paramedic services to ensure there is no disruption in our community’s access to emergency medical care,” Paradis said. “We will continue to evaluate our program and identify any modifications needed to our current practices to meet the new storage requirements while maintaining these agreements.”

Maine’s congressional delegation says health systems need additional guidance to be on the same page. The loss of medication agreements, they said, is “creating a crippling operational and financial burden for our EMS agencies.”

“We ask DEA to issue clarifying guidance as soon as possible,” the delegates wrote, “to prevent further confusion and to ensure more unnecessary costs are not borne by our EMS agencies.”