Prescribing Controlled Substances Overview

Introduction to Controlled Substances

An understanding of controlled substances is key to safe prescribing for the Advanced Nurse Practitioner. In this presentation, the Advanced Nurse Practitioner will learn about State and Federal laws that apply to the authority relating to prescribing controlled substances. In particular, ethical and fiscal considerations of prescribing will be considered. It is important for the ANP to understand the indications and contraindications for controlled substances—particularly schedule 2 drugs. The uses of these drugs will be discussed, particularly in pediatric and geriatric populations. In addition, considerations for the prevention of abuse and diversion of controlled substances will be offered, including comments on State reporting systems and the implementation and use of Prescription Drug Monitoring Programs.

Learning Objectives—Introduction to Controlled Substances

  • To understand State and federal laws that apply to the authority to prescribed Controlled Substances, REMS, and ethical and fiscal considerations of CS prescribing.
  • To identify indications and contraindications for CS prescribing, particularly in pediatric and geriatric populations.
  • To increase awareness of drug diversion and abuse, acknowledging the roles of State reporting systems and Prescription Drug Monitoring Programs.

Controlled Substances Safely

Controlled substances encompass a wide variety of medications from pain relievers to diet medications. An understanding of these drugs will help the Advanced Nurse Practitioner more safely treat patients in both the hospital and outpatient settings. In this presentation, controlled substances and their schedules will be described. Controlled substances including opiates, sedatives, stimulants, antidiarrheals, weight loss drugs, and anabolic hormones will be discussed with respect to their use, prescribing rules, and safety. Specific safety issues such as State and Federal laws regulating prescribing, risk evaluation mitigation strategies, prescription drug monitoring programs and methods to decrease diversion will be described. Methods for safe prescribing of controlled substances across the schedules will be a focus of this presentation.

Learning Objectives—Prescribing Controlled Substances Safely

  • To identify general precautions associated with prescribing controlled substances.
  • To understand why agents are classified in each of the CS schedules, and how each schedule has rules affecting prescribing.
  • To acknowledge safe methods for prescribing these agents and be able to apply them in the practice setting for CS across the schedules.

Implications of Controlled Substance Prescribing

Safe prescribing of controlled substances mandates that the Advanced Nurse Practitioner is aware of State and Federal laws regulating this process. In this presentation, rules for prescribing each of the controlled substances will be discussed. Methods to decrease drug diversion including risk evaluation mitigation strategies, prescription drug monitoring programs, and dear prescriber letters will also be illustrated. To help the ANP with prescribing certain controlled substances—the opiates--in certain situations, methods for opioid rotation, discontinuance, and use in the patient taking these medications for chronic conditions will be discussed. Finally, inappropriate prescribing and high-risk situations in which controlled substances are sometimes prescribed will be highlighted in an effort to ensure the APN uses these agents in the safest manner possible.

Learning Objectives—Implications of Controlled Substance Prescribing

  • To understand the rules for controlled substances prescribing in each of the schedules.
  • To discuss manners in which to decrease controlled substance abuse and diversion, including REMS, Dear prescriber letters and prescription drug monitoring programs.
  • To recognize high-risk use of certain controlled substances, and ways to decrease this risk, including opioid rotation, or planned discontinuance as methods of treatment.