Can Nurse Practitioners Prescribe Medication?

Nurse Types / Nurse Practitioner / Prescribing Medication

Nurse practitioners (NP) have some privileges that other nurses do not. The ability to prescribe medication to patients is one of them. You can find them in private practice settings, like community clinics and government agencies, since they can take on a physician-like role. If you have ever gone to a walk-in clinic seeking medical treatment, chances are, you have received treatment from a nurse practitioner.

In this article, we will explore:

• What is the difference between an NP and a doctor?
• What states allow NPs to prescribe medication?
• What kind of licensure do NPs need to prescribe medication?
• Which drugs can an NP prescribe?
• Can an NP prescribe narcotics?

What is the difference between an NP and a doctor?

Nurse practitioners and doctors are not as different as you may think. NPs work in medical offices and hospitals, often providing the same level of care to patients as their medical doctor counterparts.

Like doctors, nurse practitioners can:

• Act as a primary care provider
• Diagnose and treat acute conditions
• Manage patient care
• Order diagnostic testing, like lab work and X-rays
• Prescribe medications

NPs also can hold board certifications in specialties that include family practice and women’s health.

There is one notable difference between doctors and nurse practitioners. Doctors spend, on average, three more years on their education and training than NPs. Nurse practitioners must first become registered nurses, which takes two to four years depending on the route you select. Then they must obtain a master’s degree, which takes an additional two to three years. Finally, NPs must pass the APRN certification exam.  

Which states allow nurse practitioners to prescribe medications?

Nurse practitioners can prescribe medications in all 50 states and Washington, D.C. Some states have specific guidelines for nurse practitioners when prescribing medications. 

For instance, some states require nurse practitioners to demonstrate safe practice for up to one year before they can apply for a controlled substance certificate. Other states dictate that nurse practitioners must be overseen by medical doctors when prescribing medications. This means they must have a doctor authorize their prescription before it is issued to a patient. 

At present, 37 states currently require some form of medical doctor oversight for nurse practitioners when prescribing medications. States that do not require physician involvement are Alaska, Arizona, District of Columbia, Idaho, Iowa, Minnesota, Montana, New Mexico, North Dakota, Oregon, Rhode Island, and Washington.

What kind of licensure do NPs need to prescribe medication?

That depends. State licensure for nurse practitioners includes permission to prescribe medications. There is a caveat. Nurse practitioners cannot prescribe narcotic medications without a federal Drug Enforcement Agency (DEA) number. These medications, referred to as “controlled substances,” are often used in a healthcare setting for managing pain.

Due to their highly addictive nature, the DEA oversees dispensing of this classification of narcotics.  NPs can apply for their DEA number online or by calling the DEA Headquarters Registration Unit at 800-882-9539.

Which drugs can an NP prescribe?

• Antibiotics. With their APRN credentialing, nurse practitioners can prescribe antibiotics in all 50 states and the District of Columbia. Since antibiotics are not controlled substances, they pose a minimal risk for abuse or addiction.
• Antidepressants. The DEA determined antidepressants have a low risk for abuse or dependency, so they are not classified the same as narcotics. NPs can prescribe them in all 50 states and the District of Columbia.
• Birth control. Once again, the DEA does not deem birth control as addictive or habit-forming, so NPs can prescribe them within the guidelines of their state’s practice authority guidelines.
• Narcotics. The U.S. Department of Justice and the DEA tightly regulate narcotics. These agencies have classified narcotics into five categories (Schedule I-V). Please refer to our section on narcotic prescribing below for more detailed information.
• Suboxone. The brand name for buprenorphine, this Schedule III controlled substance is commonly used to help people addicted to opioids control their withdrawal symptoms. NPs with the requisite credentialing can prescribe this medication.

These are just a few of the most common medications NPs prescribe. State laws governing the prescriptive authority of nurse practitioners can change frequently, so it is best to refer to the American Medical Association’s prescriptive authority resource center to stay abreast of any modifications.

Can an NP prescribe narcotics?

The short answer is yes. The longer version requires a bit more of an explanation. As noted above, nurse practitioners can prescribe narcotics, but they must have a federal DEA number. With the prescriptive powers awarded to them by all 50 states and the District of Columbia, plus a federal DEA number, nurse practitioners can prescribe antibiotics, narcotics, and other Schedule II-V drugs.

Nurse practitioners are not permitted to prescribe Schedule I controlled substances because the DEA and U.S. Department of Justice has determined they have no currently accepted medical use in the U.S., and they have a high potential for abuse and addiction. Drugs in this category include ecstasy, heroin, LSD, marijuana, and peyote.

Some states require nurse practitioners to enroll in the Prescription Drug Monitoring Program, the Controlled Substances Reporting System, or both. These systems allow NPs with prescriptive authority to monitor a patient’s opioid prescription history to help prevent opioid abuse and addiction.

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