The regulations provide that “the secretary or agent may prepare [a] prescription for the signature of a practitioner, but the prescribing practitioner is responsible in case the prescription does not conform in all essential respects to the law and regulations” (DEA, 2010b). The CSA does not permit a prescribing practitioner to delegate to an agent or any other person the practitioner’s authority to issue a prescription for a controlled substance. A practitioner acting in the usual course of their professional practice must determine a legitimate medical purpose for a controlled substance prescription; an agent may not make this determination. Dental Considerations: The American Dental Association (2018) became the only major health professional organization to support mandatory continuing education on safe prescribing of controlled substances https://www. ada.org/-/media/project/ada- organization/ada/ada-org/ files/resources/practice/legal-and-regulatory/faq_mate- act.pdf? rev=2d62d028e6cf49869624d1cfa4e442c3&hash =A7D5EB01BC19DA0ADC5968E336996DA5 ● Required written agreement between physician and nurse practitioner. ● Limits on the number of controlled substances prescribed. ● Limits on the daily supply of a prescribed controlled substance. ● Limits placed on controlled substances prescribed in the healthcare setting. ● Requirements for a certain number of controlled substances–oriented continuing education hours. (DEA, 2022) Self-Assessment Quiz Question #2 Interns, residents, staff physicians, and advanced practice providers may prescribe controlled substances under the registration of the hospital provided that: a. The dispensing, administering, or prescribing is in the normal course of practice. b. Practitioners are authorized to do so by the state in which they practice. c. The hospital or institution has verified that the practitioner is permitted to dispense, administer, or prescribe controlled substances within the state. d. The practitioner only acts within the scope of employment in the hospital or institution. e. All of the above. regulations” rests upon the prescribing practitioner. As noted, however, a pharmacist is responsible for dispensing controlled substances. Further, “A corresponding liability rests upon the pharmacist, including a pharmacist employed by a central fill pharmacy, who fills a prescription not prepared in the form prescribed by DEA regulations” (DEA, 2018c). Therefore, a pharmacist must carefully review all purported controlled substance prescriptions to ensure the drug meets all legal requirements for a valid prescription. In addition, pharmacists must inquire further about the satisfaction of any or all of the legal requirements for a valid prescription depending upon the particular circumstances, including the condition that the prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. Finally, the pharmacist
practitioner, but a corresponding responsibility rest with the pharmacist who fills the prescription (DEA, 2010b). Laws and regulations vary from state to state; thus, the prescribing clinician must ensure that the prescription follows all requirements. Prescriptions for controlled substances must be written in indelible ink or typewritten. The controlled substance prescription must be dated and signed on the date issued. Additional requirements for a controlled substance prescription include the following: ● Patient’s full name and address. ● Prescriber’s full name, address, and DEA registration number. ● Drug name. ● Strength. ● Dosage form. ● Quantity prescribed. ● Directions for use. ● Number of refills authorized (not applicable for Schedule II drugs). ● Prescriber’s signature. ● Date issued. substances, each state has different regulations (DEA, 2022). Nurse practitioners may prescribe Schedules III, IV, and V controlled substances in all states. However, state laws to determine NPs' prescriptive authority differ considerably. Some states allow full practice for NPs where they may prescribe medications with a level of autonomy comparable to physicians. On the other hand, many states restrict NP prescriptive authority and require physician supervision. The American Association of Nurse Practitioners categorizes state practices into restricted, reduced, and complete practice authority (AANP, 2022). Twenty-two states allow full practice, where NPs have similar prescriptive authority to physicians. In 16 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 can prescribe to patients. NPs are categorized as restricted in the remaining 12 states and require physician supervision or delegation when prescribing controlled substances. Each NP should verify their state’s legal requirements and regulations for prescribing and dispensing controlled substances. There are a variety of restrictions imposed on NPs, including: ● Limits to the allowed controlled substance schedules prescribed. ● Required controlled drug substance registration or licensure.
Prescribing controlled substances: Nurse practitioner requirements While the CSA allows NPs to prescribe controlled
Special considerations for nurse practitioners prescribing controlled substances While the laws vary from state to state, no prescribers, including nurse practitioners, should prescribe controlled substances for themselves or a family member. Prescribing for family members may have legal and ethical implications. Pharmacists will likely question a prescription written for the same-named individual who signs the prescription. Patients may attempt to fill prescriptions in a different state for various reasons. A pharmacist who receives an out-of- state prescription from a nurse practitioner may only fill the prescription if unsure of the rules in the other state.
Regardless of the method of transmission of a controlled substance prescription—by hand delivery, facsimile, phone call, or electronically—DEA regulations make it clear that the legal responsibility for issuing a valid prescription that “conform[s] in all essential respects to the law and
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