APRN Prescribing Law: A State-by-State Summary

APRN Prescribing Law: A State-by-State Summary

Laura A. Stokowski, RN, MS

January 04, 2018

Independent Prescribing and APRNs

Independent prescribing (also called "prescriptive authority") is the ability of advanced practice registered nurses (APRNs) to prescribe, without limitation, legend (prescription) and controlled drugs, devices, adjunct health/medical services, durable medical goods, and other equipment and supplies. Independent prescribing does not require collaboration with a physician and is a key element of scope of practice for APRNs, as well as being part of the APRN Consensus Model, which seeks to achieve uniformity of state regulation of APRN practice.

Many states have made, and many are considering making, changes to existing laws that regulate scope of practice for APRNs, including independent prescribing privileges. Despite the existence of the consensus model, there are extensive disparities among the states with respect to prescriptive authority

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Alabama
ALABAMA
Who can prescribe?	CRNP, CNM
Are controlled substances included?	Yes; schedules III-V; limited II
Requirements for controlled substances?	DEA # ; QACSC (see key points)
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BON/BOME joint committee
Key points: CRNPs and CNMs must apply to the BON/BOME for permission to prescribe legend and specialty formulary drugs, and are authorized to prescribe with a collaborative agreement. If the collaborating physician changes, the CRNP or CNM must reapply for prescriptive authority. Prescription pads must include the physician's name and address, the CRNP's or CNM's name, RN license number, and prescription number. CRNPs and CNMs with collaborating physicians must apply to BOME for a QACSC to prescribe schedule III-V controlled substances. They can also apply for a limited-purpose permit to prescribe schedule II controlled substances. Biennial requirement of 12 CEs in advanced pharmacology and prescribing trends, plus 4 CEs for QASCS. Controlled substance prescriptions limited to 30-day supply. CNSs and CRNAs are not regulated by the BON/BOME joint committee and are not eligible for prescriptive authority.
Alabama Board of Nursing

Alaska
ALASKA
Who can prescribe?	CNP, CRNA, CNM, CNS
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA #; approval by the BON
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
Key points: Authorized APRNs have independent prescriptive authority, including controlled substances (II-V). State has adopted new guidelines for opioid prescribing. Supply limits placed on initial opioid prescriptions. All prescribers must register and are required to review the PDMP when prescribing schedules II-V controlled substances. To renew prescriptive authority, 12 of the required biennial CE hours must be in advanced pharmacotherapeutics.
Alaska Board of Nursing

Arkansas
ARKANSAS
Who can prescribe?	CNP, CRNA, CNM, CNS
Are controlled substances included?	Yes; schedules III-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	Yes (see key points)
Who grants prescriptive authority?	BON
Key points: The collaborating physician must be in same scope, specialty, or practice area as the APRN. Collaborative practice agreement includes a quality assurance plan and prescriptive protocols. Granting of prescriptive authority requires an approved pharmacology course as described in Chapter 4 rules. The APRN can prescribe only within the scope of practice of his or her certification and experience. Prescribing of controlled substances is limited to schedules III-V and hydrocodone-combination products from schedule II of the Controlled Substance Act if authorization to prescribe hydrocodone-combination products is specified in the collaborative practice agreement. Prescribers are legally required to consult the PDMP before prescribing opioids. Prescribing controlled substances requires a minimum of 2 CE hours about controlled substances; physician evaluation of any patient treated with controlled substances for chronic nonmalignant pain every 6 months; and a signed pain contract with the patient.
Arkansas Board of Nursing

Arizona
ARIZONA
Who can prescribe?	NP, CNM
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # (submit to BON and BOPh)
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
Key points: Prescriptive and dispensing authority is linked to the NP's area of population focus and certification, and prescribing without documenting an assessment is a violation of the NPA. CRNAs may order medication to be administered by a registered healthcare provider preoperatively, postoperatively, and/or as part of the procedure, but may not prescribe or dispense medications. NPs and CNMs who wish to prescribe controlled substances must hold both a DEA number and a Controlled Substances Prescription Monitoring Program registration number issued by the Arizona State Board of Pharmacy. Effective October 1, 2017, all prescribers of opioid analgesics or benzodiazepine-controlled substances must obtain (at start of therapy and quarterly thereafter) a patient utilization report from a central database tracking system for the preceding 12 months. Arizona has adopted new guidelines for opioid prescribing.
Arizona Board of Nursing

California
CALIFORNIA
Who can prescribe?	NP, CNM
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BON
Key points: NPs and CNMs can furnish (order, prescribe) drugs or devices. Applicant to furnish drugs must have completed an approved advanced pharmacology course. California provides resources for opioid prescribing.
California Board of Registered Nursing

Colorado
COLORADO
Who can prescribe?	NP, CNM, CNS, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and PDMP registration
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
Key points: Provisional prescriptive authority requires 3 years of clinical work experience, inclusion on an advanced practice registry, and an articulated plan for safe prescribing that is signed by the APRN's mentor, and reviewed annually. A 1000-hour mentorship with a physician or APRN is required for full prescriptive authority. Prescriptive authority is granted within the APRN's population and focus.
Colorado Board of Nursing

Connecticut
CONNECTICUT
Who can prescribe?	APRN, CRNA, CNM
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and state permit (see key points)
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	Nursing Statutory Scope of Practice
Key points: An APN who has completed 3 years and 2000 hours of collaborative practice with a physician who is licensed in Connecticut has full prescriptive authority. Controlled substance prescribing requires both DEA registration and a Connecticut controlled substance permit from the Department of Consumer Protection. A written collaborative practice agreement specifies which controlled substances may be prescribed and how patient outcomes will be reviewed. Prescribers must register with and review the Connecticut Prescription Monitoring and Reporting System before prescribing controlled drugs. By law, opioids for acute pain or for minors in outpatient settings are restricted to a 7-day supply. An issue brief outlines the newest laws related to opioid prescribing.
Connecticut Board of Examiners for Nursing

Delaware
DELAWARE
Who can prescribe?	NP, CNS, CRNA, CNM
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and Delaware CSR
Collaborative practice agreement?	Yes, for each practice site
Who grants prescriptive authority?	BON
Key points: Proof of at least 30 hours of advanced pharmacology and pharmacotherapeutics during the past 2 years is required if the applicant's APN program was completed more than 2 years earlier and the applicant does not have prescriptive authority in another jurisdiction. Prescriptive authority allows the APN to prescribe only noncontrolled substances. To apply to prescribe controlled substances, the APN must first hold a Delaware APN license with prescriptive authority. Delaware's controlled substances act describes new regulations for opioid prescribing, which include a 7-day limit for minors or new opioid prescriptions, patient evaluation, and patient education. In the management of chronic pain, opioid guidelines specify (among other requirements) that the prescriber must query the PMP, obtain informed consent and a signed treatment agreement from the patient, and obtain fluid drug screens every 6 months.
Delaware Board of Nursing

Florida
FLORIDA
Who can prescribe?	ARNP, CNM, CRNA
Are controlled substances included?	Yes; schedules III-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement?	Yes
Who grants prescriptive authority?	BON/BOM joint committee
Key points: Prescribers are required to use counterfeit-proof prescription pads. Prescribers must check the PDMP before prescribing controlled substances. ARNPs can prescribe controlled substances in outpatient and hospital settings using a controlled substances formulary that lists the controlled substances authorized or excluded subject to certain limits. Prescribing of schedule II drugs is limited to a 3-day supply, and no psychotropic medications may be prescribed for children under age 18 years, unless the ARNP is a psychiatric nurse. ARNPs may not prescribe controlled substances in a pain management clinic. Other limitations on controlled substance prescribing may apply. ARNP prescribers of controlled substances must have a master's or doctorate degree. Three CE hours on safe and effective prescribing of controlled substances required biennially.
Florida Board of Nursing

Georgia
GEORGIA
Who can prescribe?	CNP, CNM, CRNA, CNS
Are controlled substances included?	Yes; schedule III-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement?	Yes (called a "protocol agreement")
Who grants prescriptive authority?	BON/BOM (see key points)
Key points: Prescriptive authority for APRNs is regulated by the Georgia Composite Medical Board. The APRN and delegating physician must have comparable specialties. FAQ on prescriptive authority in Georgia can be found here. APRN prescribers are required to register with the state's PDMP.
Georgia Board of Nursing

Hawaii
HAWAII
Who can prescribe?	CNP, CNM, CRNA, CNS
Are controlled substances included?	Yes; schedule II-V
Requirements for controlled substances?	DEA # and NED registration
Collaborative practice agreement?	No
Who grants prescriptive authority?	BON
Key points: An advanced pharmacology/pharmacotherapeutics course is required. Renewal requires 8 contact hours in pharmacology related to the APRN's clinical practice specialty area. The BON develops the exclusionary formulary used for prescribing by qualified APRNs. APRNs may not prescribe investigational drugs (except as part of an IRB-approved clinical trial), stimulants and hormones for treatment of obesity, human growth hormones, anabolic steroids, hormones for performance enhancement or to reduce the impact of aging, or methadone. APRNs who are NED-registered may qualify patients for medical marijuana. Prescribers are encouraged to use the PDMP before prescribing controlled substances.
Hawaii Board of Nursing

Idaho
IDAHO
Who can prescribe?	NP, CNM, RNA, CNS
Are controlled substances included?	Yes; schedule II-V
Requirements for controlled substances?	DEA # and Idaho CSR
Collaborative practice agreement?	No
Who grants prescriptive authority?	BON
Key points: Advanced pharmacology CE requirement for renewal. (10 hours every 2 years). Prescriptive authority is limited to the APRN's practice specialty.
Idaho Board of Nursing

Illinois
ILLINOIS
Who can prescribe?	CNP, CNM, CRNA, CCNS
Are controlled substances included?	Yes; schedule III-V (see key points)
Requirements for controlled substances?	DEA # and Illinois CSR
Collaborative practice agreement?	Yes (delegates prescriptive authority)
Who grants prescriptive authority?	IDFPR (see key points)
Key points: The IDFPR grants authority and regulates practice of APNs. In Illinois, limited prescriptive authority (including prescribing controlled drugs) can be delegated to APRNs by collaborating physicians. Prescribing must be in the collaborating physician's scope of practice. If the APN is collaborating with more than one physician, a separate notice of delegation of prescriptive authority must be submitted when prescriptive authority is delegated. Requirement for monthly physician consultation has been eliminated, except for of renewal of schedule II controlled substance prescriptions. Delegated authority to prescribe some schedule II drugs is limited to oral, transdermal, or topical (but not injectable) drugs. The collaborative agreement must specify which legend and schedule II-V drugs may be prescribed by the APN. To prescribe schedule II controlled substances, APNs must complete ≥ 45 graduate CE hours in pharmacology and 5 hours annually for license renewal.
Illinois Center for Nursing

Indiana
INDIANA
Who can prescribe?	NP, CNM, CNS
Are controlled substances included?	Yes; schedule II-V (see key points)
Requirements for controlled substances?	DEA # and Indiana CSR
Collaborative practice agreement?	Yes; WCPA (see key points)
Who grants prescriptive authority?	BON with approval of BOM
Key points: Prescriptive authority requires a WCPA. Prescribing is limited to APN and collaborating physician scope of practice. APRNs are now able to prescribe schedule III-V controlled drugs for purposes of weight loss or obesity when certain conditions are met. NPs and other providers can prescribe legend drugs (but not controlled substances or abortion-inducing drugs) via telemedicine if they have established a provider-patient relationship and met the standard of care, and the prescription is within the APRN's scope of practice and certification. A new law places a 7-day limit on new opioid prescriptions. Renewal of prescriptive authority requires 30 hours of CE (8 of which must be in pharmacology). Indiana has opioid prescribing requirements for APRNs.
Indiana State Board of Nursing

Iowa
IOWA
Who can prescribe?	CNP, CCNS, CNM, CRNA
Are controlled substances included?	Yes; schedule II-V
Requirements for controlled substances?	DEA # and Iowa CSR
Collaborative practice agreement required?	No (optional)
Who grants prescriptive authority?	BON (see key points)
*Key points:* Board of Pharmacy Examiners registration required to prescribe controlled substances within the ARNP's recognized specialty. Use of PMP before prescribing controlled substances is encouraged but not mandatory.
Iowa Board of Nursing

Kansas
KANSAS
Who can prescribe?	NP, CNM, CNS
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and CSVF (see key points)
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BON
Key points: Written protocols/practice guidelines specify all drugs that may be prescribed by the APRN for each classification of disease or injury within the APRN's practice specialty. Prescribing of controlled substances requires filing a CSVF with the Kansas State BON. Prescribers are encouraged to consult the PDMP when prescribing controlled substances. The BON has a joint policy on the use of controlled substances for the treatment of chronic pain.
Kansas State Board of Nursing

Kentucky
KENTUCKY
Who can prescribe?	CNP, CNS, CNM, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and KASPER account
Collaborative practice agreement required?	Yes (CAPA—see key points)
Who grants prescriptive authority?	BON
Key points: CAPA for nonscheduled drugs (CAPA-NS; 4 years only) and for controlled substances (CAPA-CS) is required. The APRN and collaborating physician must be in same or similar specialty. Must have KASPER account to prescribe controlled drugs. By law, opioid prescriptions for acute pain are limited to 3 days. Psychostimulants can be written only for a 30-day supply by an APRN certified in psychiatric/mental health nursing who is providing services in a health facility as defined in KRS Ch. 216B or in a regional services program for mental health or individuals with an intellectual disability as defined in KRS Ch. 210. Annual pharmacology CE requirement, a portion of which must address the use of KASPER, pain management, or addiction disorders.
Kentucky Board of Nursing

Louisiana
LOUISIANA
Who can prescribe?	CNP, CNS, CNM, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and Louisiana CSR
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BON
Key points: Requires 500 hours APRN practice within previous 2 years, advanced pharmacotherapeutics course, and ongoing CE. Controlled substance prescribing for chronic/intractable pain or weight management is prohibited. For complete rules on controlled substances prescribing by APRNs, see Louisiana Administrative Code-Title 46: Professional and Occupational Standards, Part XLVII, Chapter 45. CRNAs who provide services in a hospital or other licensed surgical facilities have prescriptive authority without a collaborative practice agreement when prescribing and writing orders for services related to anesthesia care and ancillary services within these facilities. A new law places a 7-day limit on new opioid prescriptions for acute pain, and requires prescribers to check the PDMP before prescribing an opioid and every 90 days thereafter.
Louisiana State Board of Nursing

Maine
MAINE
Who can prescribe?	CNP, CNM
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
Key points: Requirement for pharmacology course/CE (45 hours) or prescribing experience and 3 hours every 2 years on opioid prescribing. CNPs can certify patients for medical marijuana. A formulary lists drugs which may be prescribed, and prescribed drugs must be related to the APRN's practice specialty. Before prescribing opioids in an outpatient setting, APRNs must review the PDMP (states or Canadian provinces). A new law places prescribing limits on daily morphine milligram equivalents and limits opioids to a 7-day (acute pain) or 30-day supply (chronic pain). Electronic prescribing is mandatory.
Maine State Board of Nursing

Maryland
MARYLAND
Who can prescribe?	CRNP, CNM
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	Maryland CSR and DEA #
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON (see key points)
Key points: Authority to prescribe legend drugs is granted by certification to practice as a CRNP. Authority to prescribe controlled substances is granted by the Maryland Division of Drug Control. Maryland requires prescribers to register with and query the PDMP before prescribing opioids or benzodiazepines. Maryland requires the lowest effective opioid dose in a quantity not greater than that needed for expected duration of pain.
Maryland Board of Nursing

Massachusetts
MASSACHUSETTS
Who can prescribe?	CNP, CNM, CRNA, PCNS
Are controlled substances included?	Yes; schedules II-V (see key points)
Requirements for controlled substances?	DEA # and Massachusetts CSR
Collaborative practice agreement required?	Yes (except CNM)
Who grants prescriptive authority?	BON
Key points: Pharmacology education requirement. Written prescriptive practice guidelines developed with collaborating physician with mechanism for monitoring prescribing practice. Initial prescription of schedule II drugs requires review within 96 hours. New regulations limit opioid prescriptions for minors and new opioid prescriptions to 7 days, and require documentation of patient education about risks associated with opioids. APRNs can certify patients for medical marijuana.
Massachusetts Board of Registration in Nursing

Michigan
MICHIGAN
Who can prescribe?	NP, NM, NA
Are controlled substances included?	Yes; schedules III-V (see key points)
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	Delegated by physician/BOM
Key points: APRNs are granted independent authority for prescribing non-controlled substances, and delegated authority to prescribe certain controlled substances (written authorization). In new legislation, Michigan requires prescribers to obtain reports from the PMP before prescribing or dispensing schedule II-V controlled substances, limits opioid prescriptions to 7 days (acute pain) or 30 days (chronic pain), parental consent for prescribing opioids to minors, and other actions. Authority to prescribe schedule II drugs is limited to a hospital (or surgical center, oncology practice, or hospice) for ≤ 7-day supply. Michigan has adopted Centers for Disease Control and Prevention opioid prescribing guidelines. In Michigan, a CRNA is not considered an APRN.
Michigan Board of Nursing

Minnesota
MINNESOTA
Who can prescribe?	CNP, CNM, CNS, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	No (see key points)
Who grants prescriptive authority?	BON
*Key points:* A collaborative agreement with a physician is required for the nonsurgical treatment of acute pain by a CRNA, and a written prescribing agreement with a physician is required for nonsurgical treatment of chronic pain. CNPs and CNSs must practice for 2080 hours within the context of a collaborative agreement within a hospital or integrated care setting with a Minnesota-licensed CNP, CNS, or physician who has experience providing care to patients with similar medical problems.
Minnesota Board of Nursing

Mississippi
MISSISSIPPI
Who can prescribe?	CNP, CNM, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # (see key points)
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BON
Key points: New APRNs must complete 720 hours of monitored practice approved by the BON before applying for controlled substance prescriptive authority by submitting a controlled substance prescriptive authority protocol and a DEA license. Already practicing APRNs need ≥ 2 CE hours in the area of controlled substance use in practice before applying for controlled substance prescriptive authority. In the absence of individual DEA registration, APRNs may determine the need for, order, and administer controlled substances within a licensed healthcare facility. Qualified CNPs can undergo training to receive expanded authorization to prescribe buprenorphine to treat opioid addiction.
Mississippi Board of Nursing

Missouri
MISSOURI
Who can prescribe?	CNP, CNM, CNS, CRNA (see key points)
Are controlled substances included?	Yes; schedules III-V (see key points)
Requirements for controlled substances?	DEA # and state BNDD registration
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BON
Key points:Initial controlled substances authority requires 1000 hours of postgraduate APRN experience and 300 hours of precepted prescribing experience. Proof of advanced pharmacology course/CE is required. Controlled substance prescriptive authority requires submission of statement of controlled substance delegation to BON and registration with Missouri BNDD. CNPs with controlled substance prescriptive authority have "restricted schedule II authority," allowing them to prescribe hydrocodone-containing medications (except to self or family members) if delegated in the collaborative practice agreement, limited to a 120-hour supply without refills. CNPs who wish to add restricted schedule II authority should follow these steps. CRNAs have prescriptive authority for general drugs but cannot prescribe controlled substances. Missouri recently created a PDMP.
Missouri Board of Nursing

Montana
MONTANA
Who can prescribe?	CNP, CNS, CNM, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
*Key points:* Advanced pharmacology course/CE that includes instruction in pharmacodynamics, pharmacokinetics, and pharmacotherapeutics and annual CE requirement. Licensure by endorsement requires evidence of a current unencumbered APRN license with prescriptive authority in another board jurisdiction.
Montana Board of Nursing

Nebraska
NEBRASKA
Who can prescribe?	CNP, CNM, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	Yes (CNP, CNM only)
Who grants prescriptive authority?	BON
Key points: CE requirement in pharmacotherapeutics. CNSs do not have prescriptive authority. A new resource, Nebraska Pain Management Guidance Document outlines the state's opioid prescribing guidelines.
Nebraska Board of Nursing

Nevada
NEVADA
Who can prescribe?	CNP, CNS, CNM
Are controlled substances included?	Yes; schedules III-V
Requirements for controlled substances?	DEA # and state CSR from BOPh
Collaborative practice agreement required?	No (see key points)
Who grants prescriptive authority?	BON and BOPh (dual application)
Key points: Advanced pharmacotherapeutics course/CE required. Prescriptive authority is optional. Newly graduated APRNs must have a protocol with a collaborative physician until they have practiced for 2 years or 2000 hours. Controlled substances prescribing is limited to the APN's defined specialty area. APRNs can take state dispensing exam for dispensing authority. Nevada has Opioid Prescribing Guidelines For Advanced Practice Registered Nurses.
Nevada Board of Nursing

New Hampshire
NEW HAMPSHIRE
Who can prescribe?	CNP, CNM, CRNA, CNS (mental health)
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and PDMP registration
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
Key points: APN educational preparation requirement includes precepted experience with pharmacologic interventions. PDMP registration must take place within 90 days of licensure. Prescribers must query the Controlled Drug Prescription Health and Safety Program before prescribing schedules II, III, and IV opioids for pain management and at least twice annually thereafter. Prescribers must follow New Hampshire Adopted Opioid Prescribing Rules. All prescribers who hold a DEA registration must complete 3 hours of continuing education or pass an online exam in the area of pain management and addiction disorder as a condition for initial licensure or renewal.
New Hampshire Board of Nursing

New Jersey
NEW JERSEY
Who can prescribe?	CNP, CNS, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and CDS registration
Collaborative practice agreement required?	Yes; joint protocol/standing orders
Who grants prescriptive authority?	BON
Key points: Certification requires a graduate-level pharmacology course/CE. Must complete 6 contact hours in controlled substances pharmacology, prescribing, and addiction. Authority to prescribe controlled substances requires CDS registration. Prescription of controlled drugs requires use of universal New Jersey prescription blanks. All prescribers must access the PDMP when prescribing controlled substances to a patient for the first time and quarterly thereafter, with some exemptions. Other opioid prescribing rules are found in Adopted Rules - Prescribing CDS and Management of Acute and Chronic Pain
New Jersey Board of Nursing

New Mexico
NEW MEXICO
Who can prescribe?	CNP, CNS, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and state CSR registration
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON/BOPh
Key points: Application requires a prescription affidavit or verification letter from preceptor and 400 hours of work experience including prescribing of dangerous drugs within past 2 years, or completion of a 400-hour preceptorship within 6 months. APRNs must maintain a formulary of dangerous drugs/controlled substances, consistent with specialty and practice setting, that may be prescribed. All APRNs with DEA registration and prescriptive authority must obtain 5 contact hours of the 15 currently required in pharmacology to include management of non-cancer or chronic pain. To prescribe opioids for longer than 4 days, APRNs must query the New Mexico PDMP initially and at least every 3 months and document findings in the medical record. Additional rules are found in Management of Chronic Pain with Controlled Substances. CNMs are regulated by the New Mexico Department of Health.
New Mexico Board of Nursing

New York
NEW YORK
Who can prescribe?	NP, CNM (see key points)
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and state CSR
Collaborative practice agreement required?	No (see key points)
Who grants prescriptive authority?	NYSED
Key points: Pharmacotherapeutic education requirement. NPs may prescribe independently after completing 3600 hours of practice with a collaborating physician and written protocols. NPs are regulated by the NYSED. To prescribe controlled substances, NPs must register with the New York State Department of Health (DOH) Bureau of Narcotic Enforcement and complete a DOH-approved 3-hour course in pain management, palliative care, and addiction within 1 year of DEA registration and once every 3 years thereafter. Attestation of completion must be submitted to the DOH. New York state prescription forms must be used for all prescriptions. Prescribing of all drugs must be done electronically directly to a pharmacy. NPs must file an Electronic Prescribing Controlled Substances registration certifying that the NP's computer application meets federal regulatory criteria for protecting the confidentiality and security of patient information. NPs must also have a Health Commerce Systems Account to access the online Prescription Monitoring Registry, which must be used when prescribing controlled substances. Prescribers must consult the PDMP before prescribing opioids, and opioids for acute pain are limited to a 7-day supply. CNMs have prescriptive authority limited to the practice of midwifery but are not regulated by the NYSED.
New York Board of Nursing

North Carolina
NORTH CAROLINA
Who can prescribe?	CNP, CNM
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BON and BOM (jointly)
Key points: Prescriptive authority is for legend drugs and controlled substances consistent with the APN's scope of practice as determined by educational preparation and national certification. APNs encouraged to register with the North Carolina Controlled Substances Reporting System. Limits exist for supply and refills of schedule II and III controlled substances. The BON has updated their policy on the use of opiates for the management of pain.
North Carolina Board of Nursing

North Dakota
NORTH DAKOTA
Who can prescribe?	CNP, CNM, CNS, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
*Key points:* Requires educational program with advanced pharmacotherapy, physical assessment, and pathophysiology or equivalent CE in pharmacotherapy. Prescribers of controlled substances are asked to participate in the North Dakota Prescription Drug Monitoring Program.
North Dakota Board of Nursing

Ohio
OHIO
Who can prescribe?	CNP, CNM, CNS
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and OARRS registration
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BON (Certificate to Prescribe)
Key points: Advanced pharmacology education, plus 6 CE in fiscal/ethical/legal principles of prescribing and 6 CE in controlled substance prescribing required. A 1500-hour externship is also required for in-state applicants, and those with prescriptive authority in other states may or may not have to complete a limited externship. APRNs must also complete a board-approved course that covers Ohio state laws that govern prescriptive authority. A "certificate to prescribe" must be earned. Prescribing is based on a formulary, and parameters for prescribing of controlled substances (by law, new opioid prescriptions limited to 7 days for adults or 5 days for minors, among other requirements) and off-label drugs must be followed. When prescribing opioids or benzodiazepines, the prescriber must request patient information from OARRS.
Ohio Board of Nursing

Oklahoma
OKLAHOMA
Who can prescribe?	CNP, CNS, CNM (see key points)
Are controlled substances included?	Yes; schedules III-V
Requirements for controlled substances?	DEA # and OBNDD registration
Collaborative practice agreement required?	Yes; supervision required
Who grants prescriptive authority?	BON
Key points: Requires academic credit hours/CE (didactic and clinical) in pharmacotherapeutic management within 3 years and annual CE required for renewal. Prescriptive authority must be consistent with the APRN's specialty and is limited by state exclusionary formulary. Written agreement from the physician supervising the APRN's prescribing is required. Prescription of controlled substances requires registration with the Oklahoma BNDD. Prescribing APRNs must register with and review data from the state's PMP before prescribing controlled substances. Supply limits on prescribing controlled substances. CRNAs may prescribe only under supervision during perioperative care, according to a CRNA Inclusionary Formulary (including schedule II-V controlled substances).
Oklahoma Board of Nursing

Oregon
OREGON
Who can prescribe?	CNP, CNS, CNM, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
Key points: APRN-level pharmacology contact hour requirement and ≥ 150 hours supervised clinical practicum that includes differential diagnosis and applied pharmacologic management of patients in the APRN's specialty or evidence of unencumbered prescriptive authority in another state with ≥ 150 hours prescribing experience within the past 2 years; or validation of prescribing competencies by a licensed prescribing practitioner that demonstrates ≥ 150 hours of the applicant's clinical expertise in pharmacologic management of patients. APRNs may not prescribe medical marijuana or drugs used in physician-assisted suicide. Prescriptive authority is limited to scope of practice. The BON has adopted the Oregon Opioid Prescribing Guidelines. When prescribing controlled substances, APRNs must provide and document patient education on the risks associated with these drugs.
Oregon State Board of Nursing

Pennsylvania
PENNSYLVANIA
Who can prescribe?	CRNP
Are controlled substances included?	Yes; schedules II-IV
Requirements for controlled substances?	DEA # (key points)
Collaborative practice agreement required?	Yes (key points)
Who grants prescriptive authority?	BON
Key points: Initial prescriptive authority approval requires evidence of at least 45 hours of advanced pharmacology at a level above that required by a professional nursing education program. Biennial license renewal requires 30 hours of CE (16 must address the CRNP's specialty). New CRNP requirements for initial or renewal prescriptive authority include 4 hours of BON-approved education (2 hours in pain management or the identification of addiction and 2 hours in the practices of prescribing or dispensing of opioids). One collaborative agreement is required for practice, and another for CRNP prescriptive authority. The CRNP Prescriptive Authority Collaborative Agreement specifies categories of drugs for which prescriptive authority is approved, and must include a request for prescribing/dispensing schedule(s) II, II and/or IV drugs if appropriate. Changes to either collaborative agreement require a specific application to the BON. Prescribing is limited to the CRNP's defined specialty. Limits on supply of controlled substances that may be prescribed. Pennsylvania has adopted guidelines on the use of opioids to treat chronic, non-cancer pain.
Pennsylvania State Board of Nursing

South Carolina
SOUTH CAROLINA
Who can prescribe?	CNP, CNS, CNM
Are controlled substances included?	Yes; schedules III-V
Requirements for controlled substances?	DEA # and state CSR
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BON (issues ID number for prescriptive authority)
Key points: Prescribing by APRNs is a delegated act, requiring an approved written protocol, limited to the APRN's defined specialty role. Initial prescriptive authority licensure requires pharmacotherapeutics education (including controlled substances). State law requires prescriptions by NPs be signed by the NP, contain the NP's BON-assigned prescriptive authority number and place of practice, and the physician's name and address preprinted on the prescription blank. CRNAs are not required to obtain prescriptive authority for the delivery of anesthesia care. South Carolina has adopted joint pain management guidelines. By law, prescribers must review a patient's history of prescription drug use in the state's PMP before prescribing a controlled substance.
South Carolina Board of Nursing

South Dakota
SOUTH DAKOTA
Who can prescribe?	CNP, CNM (see key points)
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and state CSR
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
Key points: A collaborative practice agreement is required unless or until the CNP verifies practice as a licensed CNP for a minimum of 1040 practice hours. To prescribe controlled substances, CNPs and CNMs must register with the state PDMP. CRNAs and CNSs cannot receive prescriptive authority, although CNSs may prescribe durable equipment and devices in collaborative practice.
South Dakota Board of Nursing

Tennessee
TENNESSEE
Who can prescribe?	CNP, CNS, CNM, CRNA (key points)
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	Yes; formulary required
Who grants prescriptive authority?	BON
Key points: Prescriptive authority indicated by "certificate of fitness to prescribe" held by CNP, CNS, CNM, or CRNA. A formulary describes the categories of drugs that may be prescribed by the APRN. Pharmacology education and CE in controlled substance prescribing required. Before prescribing opioids or benzodiazepines for > 7 days, APRNs must check the state's controlled substance monitoring database for the patient. APRNs must notify the BON if they are employed at a pain clinic. New legislation identifies "high-risk prescribers" and establishes new requirements for these prescribers. Tennessee recently updated their chronic pain guidelines.
Tennessee Board of Nursing

Texas
TEXAS
Who can prescribe?	NP, CNS, CNM, NA
Are controlled substances included?	Yes; schedules III-V (see key points)
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	Yes (see key points)
Who grants prescriptive authority?	BON
Key points: Advanced pharmacotherapeutics education requirement. Must apply separately for prescriptive authority for each population focus. Prescriptive authority is delegated through a prescriptive authority agreement, which is filed with the Texas Medical Board. Limitations on controlled substances prescribing (age and supply restrictions; authorization requirement for refills). Schedule II drugs can be prescribed only in specific settings (hospital facility-based practice with intended patient stay ≥ 24 hours or emergency department within a hospital, or for a patient with an executed written certification of terminal illness, receiving hospice treatment from a qualified hospice provider). CRNAs do not need prescriptive authority to administer anesthesia. The Texas legislature is currently considering a law requiring all APRNs who prescribe opioids, benzodiazepines, barbiturates, or carisoprodol to check the PMP before writing prescriptions for these drugs.
Texas Board of Nursing

Utah
UTAH
Who can prescribe?	APRN, APRN-CRNA, CNM
Are controlled substances included?	Yes; schedules III-V
Requirements for controlled substances?	DEA # and Utah CSR
Collaborative practice agreement required?	Yes, for schedule II
Who grants prescriptive authority?	Division of Occupational and Professional Licensing
Key points: APRNs may prescribe schedule III-V controlled substances. A consultation and referral plan is required to prescribe schedule II-III controlled drugs in a pain clinic or schedule II controlled drugs in all other settings. The APRN may prescribe schedule II controlled drugs in a non-pain clinic setting after meeting the lesser of two requirements (2 years of licensure as an APRN or 2000 hours of experience as an APRN). The controlled substance database must be consulted, and prescribing guidelines for treatment of an injured worker must be followed. New rules about opioid prescribing are found in the Utah Controlled Substances Act CNMs and CRNAs receive a DEA number after passing a controlled substance exam and obtaining a state-controlled substance license; CRNAs may use facility DEA numbers under certain conditions. CNMs are regulated by a separate CNM Board. CRNAs can prescribe only anesthesia care; they may not write prescriptions to be filled externally. Must complete approved CE for renewal of prescriptive authority.
Utah Board of Nursing

Vermont
VERMONT
Who can prescribe?	CNP, CNM, CNS, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and VPMS (see key points)
Collaborative practice agreement required?	Yes (see key points)
Who grants prescriptive authority?	BON
Key points: Advanced pharmacotherapeutics education is required. Collaborative practice agreement is required until the APRN has completed the 2400-hour and 2-year transition to practice period. All prescribers of controlled substances must register with the VPMS. For each licensing period, APRNs with DEA registration must complete at least 2 hours of CE on preventing opioid abuse, misuse, and diversion. See Vermont's Rule Governing the Prescribing of Opioids For Pain and the VPMS Rule.
Vermont Board of Nursing

Virginia
VIRGINIA
Who can prescribe?	LNP, CNM, CNS
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and PMP registration
Collaborative practice agreement required?	Yes; patient care team physician
Who grants prescriptive authority?	BON and BOM
*Key points:* Initial and continuing graduate-level education in pharmacology or pharmacotherapeutics required. Renewal requires biennial continuing competency documentation subject to random audit. LNPs must obtain 2 CE hours on controlled substances for license renewal. LNPs must disclose to the patient that they are LNPs. Prescribers of controlled substances must register with the PMP by the Department of Health Professions and request information from the PMP when prescribing certain drugs. Periodic electronic or chart review by the collaborating physician is required, and physician collaboration and consultation may be satisfied via telemedicine. A recent law required the BOM to establish regulations on opioid prescribing.
Virginia Board of Nursing

Washington
WASHINGTON
Who can prescribe?	NP, CNM, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
Key points: Initial and renewal pharmacotherapeutics education requirement unless applicant holds ARNP license from another state and has ≥ 250 hours independent practice experience with prescriptive authority. Prescribing is limited to scope of practice. Rules exist for prescribing for chronic pain management. Biennial renewal requires 15 hours of pharmacotherapeutic education within the area of practice. A 2017 law requires boards to adopt rules establishing requirements for prescribing opioid drugs. The Washington Health Care Authority has developed a new policy related to opioid prescribing in the state, which applies to all prescribers.
Washington Nursing Commission

Washington, DC
WASHINGTON, DC
Who can prescribe?	NP, CNS, CNM, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and DC CSR
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
Key points: Prescribers of controlled substances must apply for a DC CSR. Use of the PDMP when prescribing controlled substances is encouraged.
Washington DC Board of Nursing

West Virginia
WEST VIRGINIA
Who can prescribe?	CNP, CNS, CNM, CRNA
Are controlled substances included?	Yes; schedules III-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BON
Key points: APRNs may be granted "limited prescriptive authority." Advanced education in pharmacotherapeutics required. A collaborative agreement is required only until the APRN has completed 3 years of a collaborative relationship with a physician. Schedules I and II controlled substances, antineoplastics, radiopharmaceuticals, and general anesthetics may not be prescribed. A 30-day supply of schedule III controlled drugs (without refill) may be prescribed by the APRN. When prescribing controlled substances, prescribers must access the West Virginia PDMP. Senate bill 37 describes additional requirements for prescribers of controlled substances.
West Virginia Board of Nursing

Wisconsin
WISCONSIN
Who can prescribe?	CNP, CNS, CNM, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BON
Key points: APRNs must qualify for a certificate to issue prescription orders, after which they become advanced practice nurse prescribers (APNPs). APNPs who prescribe independently are required to carry personal liability malpractice insurance. All APNPs must pass a jurisprudence exam on Wisconsin statutes and rules pertaining to practice of APNPs. Initial requirement for clinical pharmacology/therapeutics education, and annual requirement for CE in clinical/therapeutic prescribing in the APNP's area of practice plus 2 hours on controlled substances prescribing. APNPs may issue only those prescription orders appropriate to the APNP's areas of competence, as established by his or her education, training or experience. APNPs may not issue a prescription order for any schedule I controlled substance, certain schedule II controlled substances (including amphetamines and sympathomimetic amine drugs), or anabolic steroids. Wisconsin has developed opioid prescribing guidelines and safe opioid prescribing practices for providers.
Wisconsin Board of Nursing

Wyoming
WYOMING
Who can prescribe?	CNP, CNS, CNM, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and state CSR
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
Key points: Educational requirement in pharmacology and clinical pharmacotherapeutics. Wyoming has guidelines for the management of chronic, non-malignant pain.
Wyoming Board of Nursing

Rhode Island
RHODE ISLAND
Who can prescribe?	CNP, CNS, CRNA
Are controlled substances included?	Yes; schedules II-V
Requirements for controlled substances?	DEA # and state CSR (see key points)
Collaborative practice agreement required?	No
Who grants prescriptive authority?	BON
Key points: To prescribe controlled substances, APRNs must register with the BOPh and the Rhode Island Department of Health, and complete Rhode Island Uniformed Controlled Substances Act registration. Prescribing must be within the APRN's role and population focus. CNPs can be certified to prescribe controlled substances from schedule I. CNMs are not regulated by the BON. New laws require APRNs to discuss the risks of addiction with patients when writing opioid prescriptions, and to transmit opioid prescriptions electronically to pharmacies.
Rhode Island Board of Nursing

American Samoa
American Samoa
Who can prescribe?	CNP, CNS, CRNA, CNM
Are controlled substances included?	No
Requirements for controlled substances?	N/A
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	American Samoa Health Services Regulatory Board
Key points: Prescriptive authority is restricted to the use of a protocol. NP practice requires physician supervision. For more information about advanced practice prescriptive authority in American Samoa, contact: LBJ Tropical Medical Center Pago Pago, AS 96799 Phone: 684-633-1222
American Samoa Health Services Regulatory Board (no website available at this time)

Guam
Guam
Who can prescribe?	CNP, CNS, CNM
Are controlled substances included?	Yes; schedules II-IV
Requirements for controlled substances?	DEA #; Guam controlled substances registration
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BONE
Key points: Prescriptive authority application requires post-baccalaureate pharmacology course and CE, plus 1000 hours physician-supervised experience in prescribing accumulated within 6 months. To prescribe controlled substances, the APRN must apply for this authority with the Controlled Substances Program and obtain a Guam controlled substances registration number. Prescribers are encouraged to consult Guam's PMP when prescribing controlled substances. All prescribing is done under protocols and is limited to the APRN's area of practice. CRNAs do not need prescriptive authority to provide anesthesia care.
Guam Board of Nurse Examiners

Northern Mariana Islands
Northern Mariana Islands
Who can prescribe?	CNP, CNM, CNS, CRNA
Are controlled substances included?	Yes
Requirements for controlled substances?	DEA #
Collaborative practice agreement required?	Yes; written protocols (see key points)
Who grants prescriptive authority?	NMI
Key points: APRNs are authorized to prescribe and dispense drugs and therapeutic measures described within scope of practice, defined by the board, and described in the written agreement entered into with the supervising physician. The supervising physician must have training and experience in the area of specialty in which the APRN is licensed to practice.
Northern Mariana Islands Board of Nursing

Puerto Rico
Puerto Rico
Who can prescribe?	No information available
Are controlled substances included?	No information available
Requirements for controlled substances?	No information available
Collaborative practice agreement required?	No information available
Who grants prescriptive authority?	No information available
Contact information for Puerto Rico Phone: 787-999-8989 Mail: 800 Roberto H. Todd Avenue, Room 202, Stop 18, Santurce, PR 00908
Puerto Rico Board of Nursing (no website available at this time)

Virgin Islands
Virgin Islands
Who can prescribe?	CNP, CNM, CNS, CRNA
Are controlled substances included?	Yes; schedules II-V (see key points)
Requirements for controlled substances?	DEA # ; mid-level practitioner license
Collaborative practice agreement required?	Yes
Who grants prescriptive authority?	BON
Key points: Designation for prescriptive authority requires either documentation of current authority from another state or completion of approved pharmacology course (30 credit minimum) within the preceding 2 years or 30 hours from the APRN's educational program. Continuing education of 30 hours annually required. To designate authority to prescribe, the collaborating physician must file with the board and the Composite Virgin Islands Board of Medical Examiners notice of prescriptive authority. Medication orders must be reviewed periodically by the collaborating physician. To prescribe Schedule IV or V controlled substances, APRN must obtain a mid-level practitioner controlled substance license.
Virgin Islands Board of Nursing

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