Can Nurse Practitioners Prescribe Medication?

Nurse Types / Nurse Practitioner / Prescribing Medication

Nurse practitioners (NPs) are Advanced Practice Registered Nurses. They have invested years into their education, and as a result, they have many privileges that registered nurses don’t, including being able to see and diagnose patients and create treatment plans. Though nurse practitioners often work in private practices alongside physicians, their ability to write prescriptions for medication is especially critical for patients where doctors are not readily available.

Because they can take on a physician-like role, nurse practitioners often work in community clinics and government agencies. If you’ve ever visited a walk-in clinic for medical treatment, chances are you were seen by a nurse practitioner.

In this article, we will explore:

• What can nurse practitioners do?
• Difference between practice environments
• 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?

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What can nurse practitioners do?

Nurse practitioners are Advanced Practice Registered Nurses who have pursued graduate education beyond that required to become a registered nurse. Most nurse practitioners have a minimum of a Masters’ degree, though some have doctoral degrees. Their additional training and knowledge make them eligible to provide healthcare services that registered nurses can’t, including diagnosing and managing acute, chronic, and complex health conditions. Their clinical competency is complemented by a focus on disease prevention and health promotion. 

Nurse Practitioners are qualified to provide high-quality patient care that is similar to that provided by physicians. 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. Though most nurse practitioners opt to specialize in family practice, others can choose to focus on women’s health, pediatrics, mental health, gerontology, and other areas.

One notable difference between doctors and nurse practitioners is the amount of time required for their education and training. Doctors spend, on average, three more years on their education and training than NPs. Nurse practitioners must first become registered nurses, a process that generally takes two to four years depending on whether you begin by pursuing an ADN degree or a BSN degree. After becoming an ADN- or BSN-registered nurse, nurse practitioner candidates must pursue and earn a master’s degree, which takes an additional two to three years. After this has been completed, NPs must pass the APRN certification exam.

Difference between practice environments

There are significant differences in the scope of practice permitted by different states across the country.  While some permit nurse practitioners to practice and prescribe independent of supervision, others must seek approval and authorization from supervising physicians. The different practice environments that nurse practitioners work under are:

• Full Practice – Nurse practitioners working in states that allow full practice can diagnose and treat patients and prescribe medications, including controlled substances.
• Reduced Practice – Nurse practitioners working in states that only permit reduced practice have reductions in at least one practice element.
• Restricted Practice – Restricted Practice states require nurse practitioners to adhere to delegation, team management, or supervision by another health provider.

Which states allow nurse practitioners to prescribe medications?

Nurse practitioners can prescribe medications in all 50 states and in Washington, D.C. , but different states’ laws and regulations impose specific guidelines for nurse practitioners when prescribing medications. Some require nurse practitioners to demonstrate safe practice for up to one year before they can apply for a controlled substance certificate, while others require oversight of nurse practitioners by medical doctors when prescribing medications. These rules are governed by each state’s Board of Nursing. 

At present, 37 states require some form of medical doctor oversight for nurse practitioners when prescribing medications, with some only requiring that oversight for a limited period, and some only requiring oversight for prescribing controlled substances (Nevada, Utah for those who have practiced less than 2 years or 2,000 hours), and Georgia permitting physicians to delegate authority to the nurse practitioner. 

Those states that permit nurse practitioners to prescribe after demonstrating their credentials include:

• Colorado – 1,000 hours
• Connecticut – 3 years and no less than 2,000 hours
• Delaware – 2 years and 4,000 hours
• Maine – 24 months; Maryland – 18 months
• Nebraska – 2,000 hours
• South Dakota – 1,040 hours
• Vermont – 24 months or 2,400 hours
• West Virginia – 3 years.

States that do not require physician involvement are Alaska, Arizona, the District of Columbia, Idaho, Iowa, Minnesota, Montana, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, and Washington.

What kind of licensure do NPs need to prescribe medication?

It 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 the 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?

Nurse practitioners can prescribe narcotics, but to do so 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, all nurse practitioners can prescribe antibiotics, narcotics, and other Schedule II-V drugs, but different states have different rules regarding nurse practitioner prescriptive authority for schedule II and schedule III-V controlled substances. 

Schedule III drugs are those with low-to-moderate potential for abuse and/or addiction, which are considered less dangerous than Schedule I or II. They include products containing not more than 90 milligrams of codeine per dosage unit (Tylenol with Codeine®), and buprenorphine (Suboxone®). Nurse practitioners can prescribe schedule III drugs in all 50 states and the District of Columbia.

Schedule II drugs include morphine, opium, codeine, and hydrocodone, as well as hydromorphone (Dilaudid®), methadone (Dolophine®), meperidine (Demerol®), oxycodone (OxyContin®, Percocet®), and fentanyl (Sublimaze®, Duragesic®). Some states do not permit nurse practitioners to prescribe Schedule II drugs. These include Arkansas, Florida (7-day limit except for psychiatric controlled substances), Georgia, Missouri, Oklahoma, South Carolina, and West Virginia.

Some states require nurse practitioners to enroll in a 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.

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.

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