Should nurse practitioners be able to prescribe controlled drugs in Missouri?

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With a shortage of physicians, nurse practitioners can help fill the void.

Terry McQuaide, advanced nurse practitioner, Esse Health

As an advanced nurse practitioner with offices in Illinois and Missouri, I have a unique perspective. My Illinois patients receive more efficient care for issues such as bronchitis and acute back pain based on that state’s law regarding prescribing authority.

It is well established that care coordinated by a primary care physician or nurse practitioner is higher quality and less costly for the patient and the insurer. There is a shortage of primary care physicians, and nurse practitioners are part of the solution to increase access to quality care. I work in collaboration with a physician to manage all aspects of care for hundreds of patients with chronic and acute illnesses.

It should be emphasized that restrictions are in place to curb abuse of narcotics — not because nurse practitioners do not have the skills to prescribe. In fact, nurse practitioners have in-depth training in pharmacology and are scrutinized, as are physicians, to ensure appropriate protocols are followed when prescribing any medication.

To put this in perspective: treatment for bronchitis can include cough syrup with codeine, and back pain may require a pain medication. In Illinois, after examination and diagnosis, I can write these prescriptions. In Missouri, I need to delay the patient and interrupt the physician to have him prescribe the medications. This creates unnecessary delays and may require extra trips for the patient.

Allowing nurse practitioners to practice fully in partnership with physicians will benefit patients by increasing access to quality care with no negative impact in quality or safety.

Restrictions to nurse practitioners writing prescriptions hurts health care.

Karen Kelly, associate professor and coordinator, Continuing Education at the School of Nursing, SIU Edwardsville

In 47 states, including Illinois, nurse practitioners are licensed under the states’ nurse practice acts to prescribe scheduled drugs. Illinois advanced practice nurses gained prescriptive privileges for schedule III-V drugs in 1998. In Illinois, the Nurse Practice Act “sunsets” every 10 years and must be reviewed and renewed by the Illinois General Assembly.

The 2007 Illinois Nurse Practice Act, a product of the most recent “sunset,” includes expansion of the prescriptive privileges of advanced practice nurses to include schedule II drugs, for example Ritalin or narcotic pain medications such as Demerol and Darvon. According to the American Academy of Nurse Practitioners, only Missouri, Alabama, and Florida do not grant advanced practice nurses scheduled drug prescriptive privileges. Even Georgia, the last state to grant prescriptive privileges, grants scheduled drug prescriptive privileges.

A significant body of research demonstrates the safety and efficacy of the drug prescribing practices of advanced practice nurses. This restriction on prescriptive privileges creates barriers to access to health care for those patients who receive their care from advanced practice nurses. This restriction, for example, prevents nurse practitioners who care for hospice patients from managing patients’ pain with narcotics. Additional intervention by a physician is required for pain management, adding to the cost and time needed to provide pain relief for hospice patients.

It is time for the Missouri legislature to allow nurse practitioners and other advanced practice nurses, such as nurse anesthetists, to prescribe scheduled drugs as allowed in all the states that surround Missouri.

Wisdom of Missouri’s restrictions on nurses prescribing passes test of time.

Dr. Sam Hawatmeh, internist, St. Louis

Controlled substances are essentially narcotics and other addictive drugs; they are dangerous. They must be prescribed only after a thorough medical evaluation — not a nursing evaluation and with continued medical re-evaluation — to consider dangerous interactions and side effects. The Missouri General Assembly decided 12 years ago to not allow nurses to prescribe these drugs. That wisdom has withstood the test of time.

Current law defines an advanced practice nurse as one with education beyond basic nursing education certified by a nationally recognized professional organization as having a nursing specialty. State approval via the Board of Nursing is not required!

This means that any “nationally recognized” professional organization could produce certifications for various nursing specialties, and immediately qualify advanced practice nurses in Missouri. All would have controlled substance prescriptive authority.

The nurses argue they would prescribe only pursuant to a collaborative practice arrangement with a physician. However, it is important to understand that such arrangements have no common standards and are not closely regulated.

There also is a very real concern about illegal diversion of these drugs. At a time when we’re doing everything possible to restrict the availability of dangerous drugs and substances used to manufacture meth­amphetamines, it is incongruent to dramatically expand the number of individuals who can prescribe these substances.

But the bottom line is patient safety. Controlled substances should be prescribed only by licensed physicians, podiatrists and dentists.
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