As a pharmacist or future pharmacist, it is important to understand who may prescribe drugs, particularly controlled substances, and for what conditions. Additionally, it is pertinent that one understands who may transmit a prescriber’s order to a pharmacy. In addition to physicians, there are numerous other healthcare providers that a pharmacist will be interacting with on a daily basis and it is essential that their roles be fully understood. This section will review who may prescribe controlled substances and give a refresher on their roles and limitations.
In order for an individual to prescribe controlled substances, he or she must first register with the Drug Enforcement Agency. Furthermore, California law only permits physicians, dentists, podiatrists, and veterinarians to issue controlled substance prescriptions. However, secondary personnel such as physician assistants or registered nurses may order controlled substances under the supervision and protocol of a licensed prescriber.
Mid-level practitioners such as nurse practitioners, nurse-midwives, optometrists, pharmacists, and physician assistants, are required to register with the DEA in order to prescribe, dispense, and administer controlled substances. Under California Uniform Controlled Substances Act, these individuals are recognized as practitioners. It is the pharmacist’s responsibility to ensure that each individual prescribing is within their limits established by federal and California state laws.
Out-of-state prescribers require additional analysis by pharmacists. By law, pharmacists may fill prescriptions from out-of-state but they must ask appropriate questions to make certain that the prescriber is authorized and that the order contains all information expected of a California prescriber. Schedule III-V substances may be filled from out-of-state prescribers, but not Schedule II. As always, pharmacists must use their best judgment to ensure that no acts of fraud are being committed.
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- It is the pharmacist’s duty to know whether a physician is prescribing outside his or her practice area and to make appropriate inquiries. If it a prescription is believed to not be for a legitimate medical indication, especially a controlled substance, a pharmacist should not fill the prescription. Generally, a physician may prescribe any drug or device as long as it is medically necessary.
Dentists, Veterinarians, and Podiatrist:
- In general, these practitioners may prescribe within their scope of practice. For example, a dentist may only prescribe for purposes related to dentistry such as jaws, teeth, and gums
Optometrists:
- The individual must be certifies and may only prescribe within their scope of practice.
- Registered nurses are not certified to prescribe any form of medication. They may dispense a medication to a patient under the supervision of a physician.
Nurse Practitioners:
- Nurse practitioners roles differ from that of a registered nurse. Nurse practitioners have additional training that allows them to furnish controlled substances via supervision of a physician under a protocol. The furnished controlled substances must fall under the established protocol and approved by the physician.
Certified Nurse-Midwives
- Like nurse practitioners, certified nurse-midwives may also furnish controlled substances. However, they must be related to their field of family planning or perinatal care and under physician supervision and protocol.
Physician Assistants:
- A written formulary, protocol, or advanced approval from a physician is necessary in order for a physician assistant to prescribe medications or controlled substances. The supervising physician’s information must be indicated on the prescription. Additionally, a physician assistant may transmit the order to a pharmacy.
Naturopaths:
- Naturopaths were not licensed in California until 2004. Once completing training and under physician supervision, they issue order for prescription orders including those for controlled substances under established protocol. Unlike nurse practitioners, they may not prescribe schedule II controlled substances.
Chiropractors:
- A chiropractor may not prescribe or administer any drug, but they may prescribe devices related to the chiropractic field.
Physical Therapists:
- Unlike chiropractors, they may not prescribe or administer any drug or device. If the individual is licensed under Business and Professions Code section 2620.5 to do tissue penetration they may use particular devices in their practice. They may apply topical medications.
Picture Sources:
http://www.sumnercollege.edu/career-programs/registered-nursing/
http://www.sumnercollege.edu/career-programs/registered-nursing/
http://www.chiropracticcolumbusoh.com
http://doctorsalary.blogspot.com/2011/08/infectious-diseases-physician-in-usa.html
http://doctorsalary.blogspot.com/2011/08/infectious-diseases-physician-in-usa.html
