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. ● 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) 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 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 This clinical practice guideline is intended for clinicians who are treating outpatients aged ≥18 years with acute (duration of <1 month), subacute (duration of 1–3 months), or chronic (duration of >3 months) pain and excludes pain management related to sickle cell disease, cancer-related pain treatment, palliative care, and end-of-life care (Dowell et al., 2022). This clinical practice
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.
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
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 must be satisfied that the prescription is consistent with CSA and DEA regulations before dispensing the controlled substance to the ultimate user (DEA, 2018c).
Healthcare Consideration: The number of drug overdose deaths increased by nearly 5% from 2018 to 2019 and has quadrupled since 1999. Over 70% of the 70,630 deaths in 2019 involved an opioid (CDC, 2021). Therefore, competence with both state and federal regulations should be maintained. CDC CLINICAL PRACTICE GUIDELINES FOR PRESCRIBING OPIOIDS FOR PAIN
guideline is intended to assist clinicians in weighing the benefits and risks of prescribing opioid pain medication for painful acute conditions (e.g., low back pain, neck pain, other musculoskeletal pain, neuropathic pain, dental pain, kidney stone pain, acute episodic migraine), and postoperative pain, and pain related to oral surgery procedures (Dowell et al., 2022).
CDC Clinical Practice Guidelines for Prescribing Opioids for Pain
Recommendation 1: Nonopioid therapies are at least as effective as opioids for many common types of acute pain. Clinicians should maximize nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider opioid therapy for acute pain if benefits are anticipated to outweigh risks to the patient. Before prescribing opioid therapy for acute pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy. Recommendation 2: Nonopioid therapies are preferred for subacute and chronic pain. Clinicians should maximize the use of nonpharmacologic and nonopioid pharmacologic therapies as appropriate for the specific condition and patient and only consider initiating opioid therapy if the expected benefits for pain and function are anticipated to outweigh risks to the patient. Before starting opioid therapy for subacute or chronic pain, clinicians should discuss with patients the realistic benefits and known risks of opioid therapy, should work with patients to establish treatment goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks.
Determining whether or not to initiate opioids for pain
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Book Code: DFL3024
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