Prescriptive Authority of Controlled Substances

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Prescriptive Authority of Controlled Substances Essay

The prescription of controlled substances by nurses is often one of the controversial issues that leads to the revoking of licensure only after the realization of already damaging effects of the same. The CS/CS/CS/SB 614, for instance, is a Florida 2015 law that grants APRNs the freedom to administer, dispense, or prescribe any drug including the controlled substances such as opioids (The Florida Senate, 2020).Prescriptive Authority of Controlled Substances Essay One of the issues that may arise from this prescriptive authority is the delegation of these duties by APRNs to other individuals or lack of direct examination of the patients before administration, which may lead to licensure revoking (Osborne, 2017). In the case of Heather Alfonso, a Derby APRN, her licenses were revoked and was almost imprisoned for three years for misusing her freedom of prescribing controlled substance (Chedekel, 2015). From the report about Alfonso, there was evident that she would prescribe patient medication even without proper examination by a licensed healthcare giver, and this led to many patient abnormalities until she was noticed (Chedekel, 2015).Prescriptive Authority of Controlled Substances Essay


How One Can Avoid these Situations

One can avoid these issues by performing comprehensive patient examination before any prescription activity. Also, there is need to follow the strict regulations of using these controlled substances, such as using some of the opioid medications only in the cancer treatments of pain (Soelberg et al., 2017). Lastly, a healthcare giver should always consult extensively if they are unsure that some of the medications they are giving to the patients are the best alternatives.

above is the original homework in case you needed:

CS/SB 614 authorizes an ARNP to prescribe, dispense, administer, or order any drug, which would include controlled substances.

ARNP disciplinary sanctions are added to the bill in s. 456.072, F.S., (Section 5) to mirror a physician’s sanctions for prescribing or dispensing a controlled substance other in the course of professional practice or failing to meet practice standards. Additional acts for which discipline may be taken against an ARNP relating to practicing with controlled substances that are added to the Nurse Practice Act (Section 10) include:Prescriptive Authority of Controlled Substances Essay

 Presigning blank prescription forms.

 Prescribing a Schedule II for office use.

 Prescribing, dispensing, or administering an amphetamine or sympathomimetic amine drug, except for specified conditions.

 Prescribing, dispensing, or administering certain hormones for muscle-building or athletic performance.

 Promoting or advertising a pharmacy on a prescription form unless the form also states that the prescription may be filled at the pharmacy of your choice.

 Prescribing, dispensing, or administering drugs, including controlled substances, other than in the course of his or her professional practice.

 Prescribing, dispensing, or administering a controlled substance to himself or herself.

 Prescribing, dispensing, or administering laetrile.

 Dispensing a controlled substance listed in Schedule II or Schedule III in violation of the requirements for dispensing practitioners in the Pharmacy Practice Act.

 Promoting or advertising controlled substances.

After reading the following news article

Identify what issues may arise with prescriptive authority of controlled substances and how you may avoid these situations?Prescriptive Authority of Controlled Substances Essay

Prescriptive Privileges for Advanced Practice Nurses
In order to meet the growing demand for primary care, nurse practitioners need prescriptive authority to provide quality, safe, and cost-effective healthcare to patients. The development of nurse practitioners, plus physician shortages in primary care, leads to an increasing need for nurse practitioners and access to health care. However, nurse practitioners currently face prescription regulations for controlled substances, which limits their scope of practice. The regulation of nurse practitioners prescribing controlled substances diminishes comprehensive health care services by increasing the wait time for patients and liability claims for physicians. The number of nurse…show more content…
Also, nurse leaders and physicians believed that training in primary medicine would regulate nursing education and practice. “Nurse practitioners were created in an environment of informal training, a lack of credentialing processes, increasing sophistication of medical care, and opposition” (Medscape). In 1970, Nurse practitioners stated that patients were pleased with their improved convenience of health care services. In the early 1980s, health care encountered challenges to clarify their scope of practice and nursing organizations offered titles and certifications to meet federal regulations for reimbursement (Medscape). Nurse practitioners faced several barriers to gain provider status and needed direct reimbursement to practice as independent health care providers. An aggressive campaign was created and nurse practitioners achieved legislation over 20 years, resulting in provider status in 1997. Obstacles There is an increasing demand for nurse practitioners, which makes this a crucial period in the development of their practice and profession.Prescriptive Authority of Controlled Substances Essay

In the United States, health care accessibility, quality, and affordability continue to be ongoing topics of discussion that effect many Americans on a regular basis. The need for affordable, quality healthcare continues to grow, not only due to a growing elderly population, but also as a result of the Affordable Care Act which has allowed millions of previously uninsured Americans access to health insurance and therefor better access to healthcare services (Patient Protection and Affordable Care Act, 2010). According to the Institute of Medicine (IOM) the projected demand increased for healthcare have led to a call for expansion of primary care services by policy makers (Institute of Medicine, 2010; National Governors Association, 2012).

Controlled substances are those drugs or medications that have the potential
for being misused from their original purposes. They are also considered to
be substances that have a high risk of becoming a substance use and
addiction disorder. When it comes to preventing misuse of controlled
substance and the risk of a substance use and addiction disorder, prescribing
providers can follow several clinical practices and prescribing practices that
can minimize or prevent these consequences. When prescribing drugs,
providers need to understand drug Schedules and to know which drugs are
classified according to the Schedules of Controlled Substances. The provider
should also be familiar with the laws and guidelines surrounding prescription
of substances within each Schedule, which organize drugs according to
purpose and risk for a substance use and addiction disorder.
Controlled Substances: Schedules And Terminology
In the United States controlled substances are regulated and constrained in
terms of their manufacture and distribution. Controlled substances are those
drugs or medications that have the potential for being misused from their
original purposes. They are also considered to be substances that have a
high risk of becoming a substance use and addiction disorder. Controlled
substances are classified into Schedules, which are categories that organize
drugs according to their purposes and risk for a substance use and addiction
disorder. As the numbers describing each category increase, the drugs listed
within each category decrease in their potential to cause a substance use or
addiction disorder.
While many controlled substances are referred to as “narcotics,” not all
drugs listed in the Schedules can be classified as such. The general public, 6
patients, and even some professional organizations will refer to these types
of medications as simply narcotics, which is not necessarily a correct use of
terminology. The term is sometimes applied to describe opioid analgesics. It
also is a general label that has been used to define illegal drugs. A study at
Ohio State University discussed the implications of calling all controlled
substances narcotics, as the term often has a negative connotation that
many people associate with drug use and addiction. Often, the lay public
may refer to any controlled substance, whether an opioid analgesic, a
stimulant, a muscle relaxant, or an illicit drug all under the umbrella term of
a narcotic.5
Instead of making a comprehensive statement about controlled
substances that fall under one heading, the healthcare provider should seek
to clarify the differences between each type of drug based on their purposes.
All controlled substances will be referred to according to their particular class
or purpose in this course, rather than listing controlled substances as
Controlled substances, by their very description, are drugs that must be
controlled to protect the safety and welfare of members of the population
who use them. Control of these special medications is done through
appropriate prescribing by healthcare providers, monitoring of use and
utilization of the drugs, and understanding the signs or symptoms that may
indicate a substance use and addiction disorder.
Controlled Substance Act
The management of controlled substances originally started with regulation
through legislative actions. Congress enacted the Controlled Substance Act
as part of the Comprehensive Drug Abuse Prevention and Control Act, which
was passed in 1970. There are several components of the Controlled
Substance Act (CSA), including regulation and classification of drugs 7
according to their content and purpose, regulating the manufacture of such
drugs, ensuring lawful distribution of these drugs, and regulating the sale
and exportation of certain medications. One of the main purposes of the
CSA, though, was to establish a list of Schedules, into which each drug and
medication is classified, in order to control their manufacture and
When the CSA was developed, it consolidated several laws that already
regulated the manufacture and distribution of certain substances into one
law. The controlled substances that are regulated through the CSA are
various types of drugs that can increase the potential for a substance use
and addiction disorder among those using those drugs. While opioid
analgesics make up a substantial number of controlled substances, there are
various other drugs that are also classified into the different categories,
including anabolic steroids, stimulants, hallucinogens, and depressants.
The Drug Enforcement Administration (DEA), whose job is to implement and
carry out controlled substance laws and regulations, enforces the CSA.Prescriptive Authority of Controlled Substances Essay
Among many other tasks, the organization investigates and prosecutes
those who violate the CSA and works to track and take action against those
involved with illicit drug trafficking. The DEA was originally developed in
1973 as a single organization dedicated to the control of drug use; prior to
its implementation, there were multiple organizations that controlled
different aspects of drug enforcement, but the DEA became an
establishment to combine the duties of these organizations. Although the
DEA is a government institution that works at a national level to regulate the
prescription of controlled substances, individual state laws may vary slightly
from national standards, so it is important to be familiar with the specific
laws in the appropriate state of practice. 8
In order to regulate the prescription of controlled substances, prescribing
providers must register with the DEA. This registration also applies to
pharmacists in order to be able to dispense controlled substances. The DEA
requires this registration to track and monitor those prescribing and
dispensing controlled substances according to specific numbers, which limits
access of these drugs to the general public and maintains accountability.
There are five Schedules, or classifications, of controlled substances
according to the CSA. Each Schedule has a specific set of parameters that
describes the classified drugs’ ability to cause harm, risk of causing addiction
or likelihood of being abused, and overall medical value. Schedule I drugs
have the highest potential for being abused and causing addiction; the
severity of risks associated with the drugs in each of the Schedules then
decreases as the Schedule numbers increase. The Schedules are listed up to
Schedule V, which consists of controlled substances that are considered to
have the least potential threat for abuse. The CSA may move a drug or reclassify it from one Schedule to another, or remove it entirely, depending on
the drug’s manufacturing process, state and national laws regarding the
drug’s use, and public interest.
Schedule I Drugs
Schedule I drugs are those that have the highest potential for abuse. They
have been shown to be those that have no medical use within the healthcare
community. Schedule I drugs are generally not accepted within healthcare
and are mostly considered to be illicit drugs or “street” drugs in that their
manufacture and distribution is usually illegal. Occasionally, these drugs may
be used as part of research within limited situations. 9
Drugs that are classified as being Schedule I substances are not available by
prescription and would not be legally found in a pharmacy or healthcare
institution. Examples of Schedule I drugs include heroin, lysergic acid
diethylamide (LSD), methylenedioxymethamphetamine (Ecstasy),
methaqualone (Quaalude), and mescaline (peyote).
Marijuana, which is legal for use in some states, has been classified as a
Schedule I drug. The DEA recently received petitions requesting to change
the status of marijuana to a lower Schedule for research purposes and
because it is thought to provide some medical benefits. However, the DEA
announced in August 2016 that marijuana will continue to remain a Schedule
I controlled substance, despite these petitions.21 This does not mean that
marijuana cannot be used as part of research for its health effects; keeping
the drug at a Schedule I status means that its use, whether as a research
component or as medical therapy in some states, must remain tightly


Schedule II and IIN Drugs
Schedule II and IIN drugs have less potential for abuse than Schedule I
drugs, but they still have a very high capacity for abuse and addiction.Prescriptive Authority of Controlled Substances Essay
Abuse of these drugs can lead to dependence, including physical or
psychological dependence or both types. Unlike Schedule I drugs, Schedule
II drugs have an acceptable use within healthcare and can be prescribed.
When prescribed, the orders must be written and no prescriptions may be
called in. No refills are allowed in order to reduce the chance of theft or
misappropriation of these drugs.
In some ways, Schedule II/IIN drugs have the tightest regulations when
compared to the other levels of drugs. Unlike Schedule I drugs, which have 10
no medical purpose and are usually illegal, Schedule II/IIN drugs can be
legally prescribed, making them the most dangerous of legal controlled
substances. Schedule II drugs are sometimes classified as narcotics and are
often prescribed for pain control. Examples of Schedule II drugs include
methadone, hydromorphone (Dilaudid®), oxycodone (Oxycontin®),
morphine, meperidine (Demerol®), and fentanyl.
Schedule IIN drugs have the same potential for addiction as other Schedule
II drugs but are not considered narcotics. They are often prescribed as
stimulants, to control anxiety, for control of ADHD, or to induce sleep.
Examples of Schedule IIN drugs include methamphetamine,
dextroamphetamine (Adderall®), methylphenidate (Ritalin®), pentobarbital,
and secobarbital.3

The Controlled Substances Act (CSA) imposes a unified legal framework to regulate certain drugs—whether medical or recreational, legally or illicitly distributed—that are deemed to pose a risk of abuse and dependence. The CSA does not apply to all drugs. Rather, it applies to specific substances and categories of substances that have been designated for control by Congress or through administrative proceedings. The statute also applies to controlled substance analogues that are intended to mimic the effects of controlled substances and certain precursor chemicals commonly used in the manufacturing of controlled substances.Prescriptive Authority of Controlled Substances Essay

Controlled substances subject to the CSA are divided into categories known as Schedules I through V based on their medical utility and their potential for abuse and dependence. Substances considered to present the greatest risk to the public health and safety are subject to the most stringent controls and sanctions. A lower schedule number corresponds to greater restrictions, so substances in Schedule I are subject to the strictest controls, while substances in Schedule V are subject to the least strict. Most substances subject to the CSA are also subject to other federal or state regulations, including the Federal Food, Drug, and Cosmetic Act (FD&C Act).Prescriptive Authority of Controlled Substances Essay

The Drug Enforcement Administration (DEA) is the federal agency primarily responsible for implementing and enforcing the CSA. DEA may designate a substance for control through notice-and-comment rulemaking if the substance satisfies the applicable statutory criteria. The agency may also place a substance under temporary control on an emergency basis if the substance poses an imminent hazard to public safety. In addition, DEA may designate a substance for control under the United States’ international treaty obligations. In the alternative, Congress may place a substance under control by statute.Prescriptive Authority of Controlled Substances Essay

The CSA simultaneously aims to protect public health from the dangers of controlled substances diverted into the illicit market while also seeking to ensure that patients have access to pharmaceutical controlled substances for legitimate medical purposes. To accomplish those two goals, the statute creates two overlapping legal schemes. Registration provisions require entities working with controlled substances to register with DEA and implement various measures to prevent diversion and misuse of controlled substances. Trafficking provisions establish penalties for the production, distribution, and possession of controlled substances outside the legitimate scope of the registration system. DEA is primarily responsible for enforcing the registration provisions and works with the Criminal Division of the Department of Justice to enforce the trafficking provisions of the CSA. Violations of the registration provisions generally are not criminal offenses, but certain serious violations may result in criminal prosecutions, fines, and even short prison sentences. Violations of the trafficking provisions are criminal offenses that may result in large fines and lengthy prison sentences.Prescriptive Authority of Controlled Substances Essay

Drug regulation has received significant attention from Congress in recent years, with a number of bills introduced in the 116th Congress that would amend the CSA in various ways. For example, after Congress passed several bills in recent years in response to the opioid crisis, additional proposals aimed at addressing the crisis are pending before the 116th Congress, including the John S. McCain Opioid Addiction Prevention Act (H.R. 1614, S. 724), which would limit practitioners’ ability to prescribe opioids; the LABEL Opioids Act (H.R. 2732, S. 1449), which would require prescription opioids to bear certain warning labels; and the Ending the Fentanyl Crisis Act of 2019 (S. 1724), which would increase criminal liability for illicit trafficking in the powerful opioid fentanyl. The 116th Congress has also considered measures specifically seeking to address the proliferation of synthetic drugs that mimic the effects of fentanyl, including the Stopping Overdoses of Fentanyl Analogues Act (H.R. 2935, S. 1622) and the Modernizing Drug Enforcement Act of 2019 (H.R. 2580). In addition, multiple recent proposals would seek to address the divergence between federal and state marijuana laws. Prescriptive Authority of Controlled Substances Essay For example, the Secure And Fair Enforcement Banking Act of 2019 (SAFE Banking Act) (H.R. 1595, S. 1200) would seek to protect depository institutions that provide financial services to cannabis-related businesses from regulatory sanctions, and the Strengthening the Tenth Amendment Through Entrusting States Act (STATES Act) (H.R. 2093, S. 1028) would amend the CSA so that most provisions concerning marijuana do not apply to marijuana-related activities that comply with state law. Other proposals, such as the Legitimate Use of Medicinal Marihuana Act (H.R. 171) and the Marijuana Justice Act of 2019 (H.R. 1456, S. 597) could address the gap between federal and state law in the area of marijuana regulation by moving marijuana from Schedule I to a less restrictive schedule or remove marijuana from the CSA’s schedules. Finally, recent legislative proposals would aim to facilitate clinical research involving controlled substances, particularly marijuana. These various proposals raise a number of legal questions as Congress contemplates whether to change the laws governing controlled substances. Prescriptive Authority of Controlled Substances Essay