A Study of Expanding Prescriptive Authority for Controlled Substances to

Advanced Registered Nurse Practitioners2004 HB 595

Barbara BakerJohn Perry

Purpose of the Study

• Discuss the potential positive and negative effects of authorizing ARNPs to prescribe controlled substances in Kentucky– Review research literature

• Describe ARNP education relevant to prescribing controlled substances in Kentucky– Review and compare pharmacology curriculum for

physicians and ARNPs at UK and UofL

• Gather opinions of interested and affected parties– Surveys and interviews

• Evaluate relationship between the quantity of controlled substances and ARNPs authority– Data from U.S. DEA and Verispan

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Categories of Prescription Drugs

Schedule Examples

I Heroin

II OxyContin

III Tylenol with codeine

IV Valium

V Cough syrups

Nonscheduled Drugs

Examples

Antibiotics Penicillin

Antihistamines Allegra

Cholesterol Lipitor

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Findings

• Little research has been performed specifically examining the effects of ARNPs prescribing controlled substances

• Physician and ARNP pharmacology courses at UK and UofL include similar content and time related to controlled substances – Physicians may have more time in clinical

practice

• Most states allow ARNPs to write controlled substance prescriptions 4 of

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Findings: Status of ARNP Controlled Substance

Prescribing

• All states and DC currently authorize ARNPs to prescribe all medicines except for controlled substances

• 44 states and DC grant expanded authority for controlled substances

• 36 states allow prescribing of Schedules II through V– 8 states grant full authority– 28 states grant authority with various limitations

• Kentucky is among the six states that do not allow ARNPs to prescribe controlled substances– No authorization in 6 states: AL, FL, HI, MO, KY, and GA

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Comments of Interested Parties

Proponents

• Improve access to health care

• Increase autonomy

• Increase accountability

Opponents

• Portal for drug diversion

• Question educational qualifications

• Patient safety concerns

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Findings: Practitioner Surveys

• ARNPs largely support being granted authority while physicians are generally opposed

Response ARNP Physician

Yes, no limitations 60% 4%

Yes, with limitations 36% 27%

No 3% 68%

No Opinion 1% 1%

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Findings: Practitioner Surveys

• Some agreement between physicians and ARNPs on limitations to authority if limitations are enacted

Limitation ARNP PhysicianCollaborative agreement include

specific classes of substances 64% 97%Submit collaborative agreement

to Board of Nursing 70% 90%Collaborating physician must

review ARNP regularly 61% 99%

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Findings: Data Analysis

Effect on Number of PrescriptionsSchedule II 1.4% increase per year

Schedule III 6.4% total increase

Schedule IV no effect

Effect on Quantity in GramsSchedule II 6.6% increase per year

• There is evidence that states where ARNPs can prescribe controlled substances have larger per capita quantities than states where they cannot

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A Study of Expanding Prescriptive Authority for Controlled Substances to

Advanced Registered Nurse Practitioners2004 HB 595