1. A Study of Expanding Prescriptive Authority for Controlled Substances to Advanced Registered Nurse Practitioners 2004 HB 595 Barbara Baker John Perry

2. 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 2 of 10

3. Categories of Prescription Drugs Schedule Examples I Heroin II OxyContin III Tylenol with codeine IV Valium V Cough syrups Nonscheduled Drugs Examples Antibiotics Penicillin Antihistamines Allegra Cholesterol Lipitor 3 of 10

4. 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 4 of 10

5. 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 5 of 10

6. Comments of Interested Parties Proponents Improve access to health care Increase autonomy Increase accountability Opponents Portal for drug diversion Question educational qualifications Patient safety concerns 6 of 10

7. Findings: Practitioner Surveys ARNPs largely support being granted authority while physicians are generally opposed Response ARNP Physician Yes, no limitations 60% 4% Yes, with limitations 36% 27% No 3% 68% No Opinion 1% 1% 7 of 10

8. 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% 97% Submit collaborative agreement to Board of Nursing 70% 90% Collaborating physician must review ARNP regularly 61% 99% 8 of 10

9. Findings: Data Analysis Effect on Number of Prescriptions Schedule II 1.4% increase per year Schedule III6.4% total increase Schedule IVno effect Effect on Quantity in Grams Schedule II6.6% increase per year There is evidence that states where ARNPs can prescribe controlled substances have larger per capita quantities than states where they cannot 9 of 10

10. A Study of Expanding Prescriptive Authority for Controlled Substances to Advanced Registered Nurse Practitioners 2004 HB 595