Advanced practice nurse controlled substances prescriptive authority: A review of the regulations and implications for effective pain management at end-of-life

Advanced practice nurses play significant roles in providing care to patients with advanced disease. Their roles are enhanced when they can prescribe controlled substances, especially opioid analgesics essential for the management of moderate to severe pain in persons at the end of life. A review of state laws and regulations shows that although advanced practice nurses have some degree of prescriptive authority in all 50 states and the District of Columbia, there are restrictions on their prescribing of controlled substances. In 40 states, advanced practice nurses have differing authorities to prescribe schedule II-V controlled substances; in eight states they can prescribe only schedule III-V drugs. Three states do not allow advanced practice nurses to prescribe controlled substances. Inappropriate restrictions on the ability of advanced practice nurses to prescribe the full range of controlled substances needed to control pain and other symptoms may negatively affect quality of care, especially in persons at the end of life.