1. SUPPORT HB _____ and SB _____ : NURSE PRACTITIONER PRESCRIPTIVE AUTHORITY <br />OF CONTROLLED substances in Schedules II to V<br />Representative Ronald Johnson and Senator Linda Coleman introduced HB ___ and SB ____, respectively, to allow certified registered nurse practitioners and certified nurse midwives prescription authority for controlled substances in schedules II to V in Alabama.<br />Who are advanced practice nurses? Certified Registered Nurse Practitioners (CRNPs) and Certified Nurse-Midwives (CNMs) are licensed health care professionals. In collaborative practice with physicians, CRNPs and CNMs practice in primary and specialty care to provide a broad range of diagnostic and therapeutic services, including prescribing medication.<br />What do HB ____ and SB ____ authorize? If passed, the bills would authorize CRNPs and CNMs the ability to prescribe controlled substances in schedules II to V.<br />What are controlled substances in schedules II to V? Controlled substances are an integral component of medical care. Their uses are wide and varied. In primary care, controlled substances are used for treating coughs, anxiety, insomnia and pain. In pediatric settings, controlled substances are used to help with attention deficit disorders. In end of life care, controlled substances are used to ease discomfort and suffering of disease and dying. In surgical practices and specialty practices, controlled substances are used in the treatment of postoperative pain, for immediate treatment of trauma patients whose injuries require transport for stabilization, in emergency departments, and by health care teams who care for patients with terminal illnesses. Because these medications have a high potential for abuse, dependence, and diversion, they are specially regulated in the law (controlled by the DEA).<br />Do other states authorize CRNP and CNM prescribing of controlled substances? Yes. Forty-eight (48) states and the District of Columbia currently authorize CRNPs and CNMs to prescribe controlled medications (only Alabama & Florida do not). No state that enacted provisions to authorize CRNPs or CNMs to prescribe controlled medications ever rescinded the law. <br />Will there be state oversight of controlled substances prescribing authority? Yes. When HB ___ and SB ___ pass, prescriptive authority for controlled substances for CRNPs and CNMs will require a state controlled substances registration certificate as well as a federal Drug Enforcement Administration (DEA) registration number. CRNPs and CNMs will be held to the same state and federal standards as other clinicians (physicians, dentists, podiatrists, and veterinarians) who prescribe controlled medications.<br />Are CRNPs and CNMs qualified to prescribe controlled substances? Yes. All CRNPs and CNMs students in the U.S. receive an average of 90 hours of classroom instruction in pharmacology. Students in Alabama CRNP and CNM programs receive the same amount of pharmacological education and training as students in states where CRNPs and CNMs write prescriptions for controlled substances. In addition to classroom instruction, CRNP and CNM students are trained with greater than 600 hours of applied pharmacology during clinical preceptorships and clinical experiences. Additionally, CRNPs and CNMs are required 6 pharmacology continuing education credits to renew their nursing license.<br />Will this affect patient care? Yes. CRNPs and CNMs commonly extend care to underserved populations. This is most effective when the CRNPs and CNMs are empowered to adequately provide primary care services, including prescribing controlled substances. Authorizing CRNPs and CNMs to prescribe controlled substances will increase the quality of care for patients by decreasing unnecessary pain and suffering and treatment delays. <br />Currently, the law results in inefficient and substandard patient care. CRNPs and CNMs in Alabama have the responsibility to diagnose and assess pain, disease, and acute illness, yet no authority to treat it appropriately. Scope of practice barriers to scheduled prescribing mean that patients must do without needed pain medication and create time delays (to call/find a physician to prescribe needed medications). Additionally, to prescribe controlled substances in schedule II the physical presence of the physician is required. <br />Eliminating these prescriptive barriers would improve care by giving patients what they need when they need it, thus, improving the quality, decreasing time to provide care, decreasing the number of visits, and the cost of the care they receive. Examples of medications that are scheduled substances are: Lomotil (used to treat diarrhea), cough suppressants/pain medications (for pneumonias, bronchitis, injuries/broken bones, etc.) and Concerta (used to treat attention deficit disorders).<br />