Can a family nurse practitioner prescribe medication

In general, PAs can prescribe medications in collaboration with supervising physicians. However, specific states prohibit PAs from prescribing Schedule II controlled substances. As of 2010, PAs were allowed to prescribe controlled substances except for in two states—Kentucky and Florida.[4] However, in 2016 Florida approved House Bill 423 to allow PAs and NPs to prescribe Schedule II-V drugs. One stipulation of HB 423 includes limiting the prescription of Schedule II substances to a 7-day supply. Other conditions include requiring continuing education to ensure the safety of prescribing controlled substances.

Georgia and Texas restrict PAs from prescribing Schedule II medications; however, they can prescribe Schedule III-V drugs.[5] Additionally, Arkansas and Missouri only allow PAs to prescribe hydrocodone combination products listed under Schedule II medications. Many other states have limitations on the supply that may be prescribed and dispensed. For example, PAs' prescription of Schedule II drugs is limited to a 30-day supply in Arizona, Illinois, Montana, North Carolina, Pennsylvania, and South Dakota. Certain states also restrict the ability of PAs to prescribe refills for Schedule II drugs by requiring supervising physician approval. Some states also require PAs to complete board-approved courses on controlled substances before they are allowed to prescribe scheduled medications.[4]

Some state laws also specify a formulary of drugs that PAs are unable to prescribe. For example, Florida Admin. Code R. 64B8-30.008 sets multiple stipulations for PA prescribing capabilities.[6] The Florida formulary does not allow PAs to prescribe general anesthetics or psychiatric medications for patients under 18 years old. Other states with a restricted medication formulary include Georgia, New Mexico, Ohio, Oklahoma, and West Virginia. Overall, PA scope of practice laws is expanding, with prescriptive restrictions being lifted over time.[7]

State laws to determine NPs' prescriptive authority differ considerably. Some states allow the full practice of NPs where they may prescribe medications with a level of autonomy comparable to physicians. On the other hand, many states have restrictions on NP prescriptive authority and require physician supervision. The American Association of Nurse Practitioners categorizes state practices into three divisions: restricted, reduced, and complete practice authority. Twenty-two states are classified as full practice where NPs have similar prescriptive authority to physicians. In sixteen states, NPs have reduced authority and work alongside physicians in joint practice agreements. States with reduced prescriptive authority have varying limitations on medications that NPs have the authority to prescribe to patients. NPs are categorized as restricted in the remaining twelve states and require physician supervision or delegation when prescribing controlled substances. Overall, NPs have a broader scope of practice and fewer limitations on prescriptive authority than PAs, particularly in states that allow full practice.

NPs have the prescriptive authority to prescribe controlled substances in all fifty states. However, NPs cannot prescribe Schedule II medications in Georgia, Oklahoma, South Carolina, and West Virginia.[4] Furthermore, state legislation in Arkansas and Missouri restricts NPs to prescribing only hydrocodone combination medications listed under Schedule II. Notably, surveys have shown that many NPs have used strategies to prescribe controlled substances which were not strictly legal. These strategies included using pre-signed prescription pads, having a physician sign the prescription without consulting them, and prescribing scheduled medications without physician involvement.[8]

Notably, the passage of legislation allowing for the greater prescriptive authority does not equate to uptake by advanced practice providers. For example, in 2001, Washington state passed laws to allow NPs to prescribe Schedule II-IV medications under a joint practice agreement with a physician. However, NPs were required to apply to the DEA to obtain the increased prescriptive authority. Surprisingly, only 60% of NPs submitted applications to prescribe Schedule II-IV drugs following the new law's implementation.[9] Reasons for the low uptake of expanded prescriptive authority included concerns about knowledge, questions regarding discipline by regulatory agencies, and concerns about working with patients with drug-seeking behaviors.

Some physician groups have expressed concern relating to the increasing prescriptive authority by advanced practice providers. The current literature is mixed of differences in provider care concerning physician and advanced practice providers. Certain studies have highlighted higher average opioid prescriptions written by NPs and PAs compared to physicians.[10][11] However, other studies have shown that the overall prescribing patterns of advanced practice providers are comparable to those of physicians.[12] One study found that PAs were slightly more likely to prescribe controlled substances to patients than physicians or NPs.[13] Moreover, researcher bias may be contributing to the often opposing conclusions demonstrated in the literature.

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