Transcript No Slide Title

A Study of Expanding Prescriptive
Authority for Controlled Substances to
Advanced Registered Nurse
Practitioners
2004 HB 595
Barbara Baker
John 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
Nonscheduled
Drugs
Antibiotics
Antihistamines
Cholesterol
Schedule
Examples
Examples
Penicillin
Allegra
Lipitor
I
Heroin
II
OxyContin
III
Tylenol with
codeine
IV
V
Valium
Cough syrups
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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
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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
Opponents
• Improve access to
health care
• Portal for drug
diversion
• Increase autonomy
• Question educational
qualifications
• Increase accountability
• 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
4%
60%
Yes, with limitations
27%
36%
No
3%
68%
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Findings: Practitioner Surveys
• Some agreement between physicians and ARNPs
on limitations to authority if limitations are
enacted
Limitation
ARNP Physician
Collaborative agreement include
specific classes of substances
64%
Submit collaborative agreement
to Board of Nursing
70%
97%
90%
Collaborating physician must
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Findings: Data Analysis
• There is evidence that states where ARNPs can
prescribe controlled substances have larger per
capita quantities than states where they cannot
Effect on Number of Prescriptions
Schedule II
1.4% increase per year
Schedule III
6.4% total increase
Schedule IV
no effect
Effect on Quantity in Grams
Schedule II
year
6.6% increase per
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A Study of Expanding Prescriptive
Authority for Controlled Substances to
Advanced Registered Nurse
Practitioners
2004 HB 595