Controlled substances — meds deemed to have high potential for danger and abuse — are regulated under federal mandate. However, when it comes to who’s authorized to prescribe these agents, the states have been left to their own devices. And in some states, nurse practitioners and physician assistants are greatly restricted in what we’re allowed to prescribe.
Our hands shouldn’t be tied this way. Here’s why: Currently, we are permitted to prescribe noncontrolled substances in all 50 states. This includes such potentially dangerous medications as digoxin and insulin, which, if prescribed incorrectly, can kill.
Most state medical associations have lobbied against broadened NP and PA practice rights under the guise of patient safety. But given the fact that the harmful effects of controlled medications are considerably less grave (pardon the pun) than those mentioned above — this simply does not make sense.
Additionally, these initiatives serve as a de facto limit-setter on appropriate care. That’s because when patients present to NPs or PAs, we often cannot legally provide appropriate care. Consider the case of pediatric and primary-care NPs in states that don’t authorize NPs to prescribe class II drugs. When that happens, children are denied access to most ADHD medications. Or think of the dilemma faced by patients who require more potent pain medication than what a particular state allows but can’t get it because of NP or PA prescribing limitations. Even in practices where NPs, PAs, and physicians collaborate, the physicians’ days off can greatly decrease access to full-service care.
Overall, however, our practice environment is gradually improving, notwithstanding pockets of organized resistance and restrictive state legislation.
With the recent addition of Georgia, all 50 states now allow NP prescribing. Fully 47 allow some level of controlled-medication prescribing but place limits on NPs’ ability to prescribe higher-potency pain meds. In the three worst cases, Florida, Alabama, and Missouri deny NPs the right to prescribe any controlled substances.
While PAs tend to practice in closer proximity to supervising physicians than NPs, any limitation represents an inconvenience and, when the physician is indisposed, a potentially dangerous one.
Consider a PA in Alabama who works in a cardiothoracic surgery practice and is discharging a patient but can’t prescribe pain meds because his surgeon is in the operating room. This could delay discharge and even result in the patient’s receiving inappropriate care.
Physicians, NPs, and PAs alike respect the scientific evidence supporting any number of treatments and practices. Why can’t the equally valid evidence that shows us how to be competent practitioners be respected in the same way? Patient care shouldn’t be a pawn in a political struggle for control of health care. The level of collaboration between NPs, PAs, and physicians in clinical practice is impressive; in fact, to physicians with whom I work, prescribing limitations are a senseless inconvenience.
In the end, the squeaky wheel usually gets the grease. We must lobby our state legislators and support our professional organizations. Only through repeatedly registering our dissatisfaction with the status quo will we alter the practice environment to our liking. We’ve come a long way, but when it comes to prescribing rights, we still have a long way to go.