Describe a nurse practitioner’s controlled-substance prescriptive authority

How does your state describe a nurse practitioner’s controlled-substance prescriptive authority, and what nurse practitioner drug schedules are nurse practitioners authorized to prescribe?

Prescription drug abuse by the general public is an ongoing problem. The United States Department of Health and Human Services estimates that nearly 10% to 20% of all patients in emergency departments have abused prescription drugs, with over half of these abusing more than one substance at once.1 It has also been reported that approximately 2 million Americans are addicted to painkillers alone2; however, it should be noted that this number may actually be much higher as many addicts do not seek treatment for their addiction.3 In addition, there are several other factors which contribute to prescription drug abuse including access to medications without prescriptions, lack of knowledge about safe medication use, misuse or diversion of legitimate medications, and inadequate monitoring procedures to prevent such incidents.4–6

In response to this growing epidemic, health care professionals must take measures to ensure patient safety while prescribing controlled substances.7 These efforts include educating physicians on appropriate prescribing practices, ensuring proper documentation of orders, developing policies and protocols regarding dispensing controlled substances, implementing systems to monitor and control controlled substances, and maintaining adequate supplies of controlled substances.8 However, nurses who prescribe controlled substances often face unique challenges when performing these responsibilities due to differences between nursing practice models and physician practice patterns.9 For example, nurses practicing under traditional hospital settings usually work independently from physicians, whereas those working within ambulatory clinics typically function as part of a multidisciplinary team.10 Nurses employed in either setting will therefore require different skillsets to safely administer medications. The American Nurses Association has developed this policy to clarify the scope of practice for nurses who prescribe controlled substances under state laws. This document is intended as an informational resource only and does not establish or change legal rights, duties, or privileges that may be applicable in specific situations. It should be noted that some states have established additional requirements based on their own statutes or regulations. Therefore, it is important for each individual state to review its law regarding these issues.

The ANA believes that all registered nurses are competent to safely administer medications; however, there are many factors that can limit a nurse’s ability to do so. For example, certain drugs require special training—such as those used by paramedics—and others carry risks associated with drug interactions. In addition, prescribing practices vary from one setting to another, and different types of patients present unique challenges when it comes to safe medication administration. Finally, because prescription medications are regulated products, they must meet federal standards before being released into interstate commerce. As such, the following information provides guidance about what constitutes appropriate nursing practice related to controlled substance prescriptions.

This policy applies primarily to nurse practitioners but also includes other advanced practice clinical providers licensed in the United States who prescribe controlled substances. However, if you are unsure whether your license meets the criteria outlined below, please consult with your licensing board.

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