Prescribing controlled drugs

One of the more frustrating aspects of working in Florida is that NPs are not allowed to prescribe any controlled drugs. Not just schedule II drugs, as in some states, but all scheduled drugs. The law not only confounds NPs in hospice and palliative care, but in nearly every other specialty. Psychiatric NPs can't independently prescribe Ritalin, and how often does one suppose there is the need? In my practice, I need to prescribe scheduled drugs every day. Because I work in an inpatient unit with a physician usually nearby, I can get things done fairly efficiently, but there isn't always a physician available.

So how do I manage? What I do, is write the orders, which means doing all the medical decision making, then the MD signs the order. All of the MDs I work with trust all of the NPs in our practice, and they may read the order but rarely question it. The extra step of getting the signature is time consuming and disruptive, and most importantly adds nothing to the process.

When I work on the home teams it's a different story. I carry a small laptop computer, and send the order by email to the team MD for signature. The MD may not be available at the time, or the technology may not be working so the email is slow to arrive. It can be hours by the time the patient finally gets the medication needed for symptom management.

For this reason, the NP groups in Florida have worked year in and year out to get legislation passed to reverse the law. The studies clearly show the safety of NPs prescribing scheduled drugs. The issue is about power and money. NPs in other kinds of practices have to have a "supervising" physician, who does nothing more than review charts on a monthly basis and is available to sign these kinds of prescriptions. The NPs have to pay the MD for this service, and in Florida many retired MDs use this to supplement their income. The Florida Medical Society supports many of the legislators, so it's difficult to get our bills through.

For me, the issue is really about access to care. While everyone is worried about power and money, people are not getting the care they need in a timely manner. To have to wait as much as 8 hours, as one patient I know did, for pain medication to finally be delivered, is criminal. If any one of these legislators had to wait like that, suffering pain and shortness of breath, there would no longer be an argument.

There seems to be more support in the Florida legislature this year. I'm hopeful. Stay tuned.