Prescriptive Authority for Advanced Registered Nurse Practitioners

 Advanced registered nurse practitioners (APRN) have been practicing in Florida since 1975 but were not able to prescribe controlled substances until recent years. Practitioners would refer their patients to a physician who would then independently evaluate the patient’s need for drug therapy.        

The 1996, Florida Legislatures required a task force to evaluate the restriction of controlled substances, the medical necessity for the restriction, and the potential for harm if the restriction was lifting. The law also required the task force to study the training and education of ARNPs, and the potential risks and liabilities if they were to prescribe controlled substances. In 1997, the task force recommended that advanced registered nurse practitioners should be allowed to prescribe controlled substances with proper training through approved courses and experience (2008).

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        Florida became the last state to authorize prescriptive authority of controlled substances to advanced registered nurse practitioners. Effective January 1, 2017, HB 423 authorized ARNPs to prescribe, dispense, order, and administer controlled substance under a physician’s supervision (HB423). This bill was name the Barbara Lumpkin Prescribing act and was a giant step for Florida practitioners.

        Barbara Lumpkin is a Florida lobbyist who has advocated for nursing professions for the past 4 decades. With the passing of this law, patients will no longer have to wait to see another medical profession to receive their prescription reducing costs and improving efficiency.

With the approval of this act, Florida practitioners, ARNPs and CRNAs, will be able to provide medications such as narcotics and ADHD medications under existing supervision.

        The approval of this law does not come without a protocol to ensure safety amongst Floridians. Any prescription for a Schedule II controlled substance is limited to a 7-day supply. An amendment to the bill specifically states that this does not apply to medications ordered by CRNA’s for pre-anesthesia, anesthesia, and post-anesthesia. The bill requires 3 hours of continuing education every 2 years with a focus on prescribing safety, and APRN’s must graduate from a master’s or doctoral degree to be eligible to prescribe. With this bill, practitioners are held to the same disciplinary standard as physicians. ARNP’s are now a part of the Florida Comprehensive Drug Abuse Prevention and Control Act, and they are required to comply with the prescribing requirements and limitations of this act.        

         A new law just went into effect as of July 1 of this year. It addresses opioid abuse by expanding the use of the Prescription Drug Monitoring Program (PDMP), increasing regulation of prescribers and dispensers, amending criminal laws, and making appropriations (HB21 summary). The most important change is that providers must consult the Prescription Drug Monitoring Programs (PDMPs) database to review dispensing history before prescribing controlled substances. This new bill also limits prescriptions for Schedule II opioids for acute pain to 3 days, unless providers writes “acute pain exception” and meets the exception criteria which allows a 7-day prescription.

        On June 22, 2018, the Support for Patients and Communities Act, was passed by the House of Representatives. This new bill enables certified registered nurse anesthetists to prescribe buprenorphine, and make buprenorphine prescribing authority for nurse practitioners permanent. There is no date yet for when this law will go into effect, but by allowing ARNP’s to prescribe buprenorphine in combination with counseling and behavioral therapies provide a whole-patient approach to the treatment of opioid use disorders (HR 6).

        A gap in the law that will hopefully be addressed in the future is the fact that ARNP’s can prescribe controlled substances but still need existing supervision by a medical doctor or dentist. According to state law, Florida all ARNP’s do not have the ability to practice completely independently. As time passes, hopefully these concerns will be addressed, and new laws passed to allow for full independence in Florida. 

        One problem found with the evolution of prescriptive authority for advanced registered nurse practitioners is that it took twenty years for a new law to be passed. In 1997, the appointed task force by Florida Legislation recommended that ARNP’s should be allowed to prescribe controlled substances with proper training and experience, but yet it took two decades before the Barbara Lumpkin Prescribing act was passed. It will be a slow process to improve prescriptive authority, but with the continued work of all ARNP’s coming together, we can fight to increase our scope of practice which will increase access to prescriptions and healthcare for Americans while decreasing costs. 

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