Welcome to Rx week here at MidlevelU! With a new class of nurse practitioner grads finishing up NP programs this summer, I thought it would be good to take some time to look at the legal implications of prescription writing as a nurse practitioner. Embarrassingly, even as a seasoned NP, I have learned a few things in the process of writing this week’s posts. So, let’s get started with the basics and take a look at controlled substances and what nurse practitioners need to know about these types of medications.
Early in my practice I was a bit foggy when it came to the exact definition of a controlled substance. Ignorant, I know, but as a result of the rules and regulations surrounding NP practice in my state the issue never affected my practice. I naively assumed that all prescriptions medications were classified as controlled substances. This is incorrect.
Controlled substances are defined as drugs or chemicals whose manufacture, possession, or use are regulated by the government. In the United States, controlled substances are regulated by the Controlled Substances Act and are regulates by the Drug Enforcement Administration (DEA). When it comes to drugs/medications, controlled substances are those that the government deems to have a high potential for abuse. Controlled drugs are divided into five categories called schedules.
- Schedule I drugs are those that have the highest potential for abuse and currently have no accepted medical use. Schedule I drugs include substances like heroin, marijuana and methamphetamine.
- Schedule II drugs have a high potential for abuse and may lead to physical and/or psychological dependence. These drugs have a current accepted medical use. Examples of Schedule II substances include medications like morphine and oxycodone.
- Schedule III drugs have a lesser potential for dependence and abuse than those in prior schedules although abuse remains a risk. Typically, with Schedule III medications abuse leads to a low or moderate level of physical dependence and a high level of psychological dependence. Examples of Schedule III medications include hydrocodone or codeine with acetaminophen and ketamine.
- Schedule IV drugs have an even lower potential for abuse relative to drugs in previous schedules. Abuse of Schedule IV drugs leads to only a limited level of physical or psychological dependence. Examples of Schedule IV substances include Valium and Xanax.
- Schedule V drugs have a low potential for abuse relative to drugs in other schedules leading to only limited dependence. Examples of Schedule V medications include cough medicines containing codeine and Lyrica.
Each year the DEA publishes a list of controlled substances and their schedule rankings. Although this list contains many medications one would expect such as Adderall and oxycodone, some unassuming medications are included in the DEA’s list of controlled substances. Nurse practitioners must familiarize themselves with this list, especially if practicing in a state that limits NP’s ability to write prescriptions for scheduled medications.
Many commonly prescribed meds, such as antibiotics, are not considered controlled substances. This means that a DEA number is not required to write prescriptions for these medications (although other federal and state qualifications are required). Laws regulating nurse practitioner’s ability to prescribe scheduled medications would also not apply to non-controlled substances.
It is essential for nurse practitioners to understand drug scheduling as state laws regulating NPs often refer to these schedule classifications. For example, nurse practitioners practicing in Florida are not allowed to write prescriptions for controlled substances. Nurse practitioners in Georgia are not permitted to prescribe Schedule II controlled substances. To practice in compliance with state law, NPs practicing in these states and other with similar regulations must be aware of medication schedules to practice within state guidelines.
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