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Florida ARNP's OPIOID PRESCRIBING

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by casias12 casias12 (Member) Nurse

casias12 has 30 years experience and specializes in Cardiology nurse practitioner.

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Summary: HB 423 passed in Florida this year, and will allow for precribing controlled substances by ARNP/PA's in Florida beginning January 1, 2017. While it includes all scheduled drugs, my question pertains to opioids.

I just attended a course which was supposed to answer all of the questions, but I left with more questions than answers.

The basics of the law are:

1) Must be MSN or higher.

2) CS II are limited to 7-day supply. All others, CS III-V are without limits or forumlary.

The most concerning statement they made in the conference, over and over and over, was that the law does not support prescribing for non-malignant, chronic pain. However, this is the update on the Florida BON website that discusses this. Am I missing something?

From Florida BON website. (Bold added). Florida Board of Nursing >> *UPDATE* – Register As A Controlled Substance Prescriber - Licensing, Renewals & Information

In accordance with section 456.44(2), Florida Statutes, an allopathic physician licensed under Chapter 458, an osteopathic physician licensed under Chapter 459, a podiatric physician licensed under Chapter 461, a dentist licensed under Chapter 466, a physician assistant licensed under Chapter 458 or Chapter 459, or an advanced registered nurse practitioner certified under part I of Chapter 464 who prescribes any controlled substance listed as Schedule II, Schedule III, or Schedule IV narcotics as defined in s. 893.03, FOR THE TREATMENT OF CHRONIC NONMALIGNANT PAIN, must designate himself or herself as a controlled substance prescribing practitioner on the practitioner profile.

And at the bottom of the announcement from the same web page

Chronic nonmalignant pain” is defined as pain unrelated to cancer which persists beyond the usual course of disease or the injury that is the cause of the pain or more than 90 days after surgery.

And here is the portion of the law regarding this, lines 230-237. Click on pictures to see entire document.

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Buyer beware has 40 years experience as a BSN and specializes in GENERAL.

1,137 Posts; 11,285 Profile Views

OP:

I will just say this:

Just try as a patient to get even a 7 day supply of opioid drugs from most physicians in Florida these days for ANY reason especially if they don't know you. You can forget it.

Those days are over.

You know the historical drill, I hope, of the drug armageddon that has gone on here and continues to go on.

The pill mill "businessmen" along with their physician accomplices are now charged with murder and/or sitting in jail.

OP consider this law as a protective one for all concerned.

Yes, it's paternalistic but so it goes.

Take care of the people who want you not the ones who need you as a one stop destination for someone's drug needs.

The last thing you want to deal with is a good intentioned murder wrap.

Do youself a favor. If you feel comfortable do it as sanctioned by law.

Otherwise send them to the dolorologist kicking and screaming that they'e going to kill you if need be.

It beats personal and professional doom.

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casias12 has 30 years experience and specializes in Cardiology nurse practitioner.

101 Posts; 2,879 Profile Views

I've never tried to get opioids from a physician, so I don't know what it is like. But I do know many physicians who prescribe regularly, even for chronic non-malignant pain.

That being said, a prudent clinician is going to assess the patient to determine the type of pain, and clearly document it. Then create a plan that includes alternative non-opioid treatment. Having a pain contract with the patient has to include requirements on the patient's part to trial non-opoioid options. Failing to follow the contract leads to dismissal.

The standard in Florida is 3 month visits. Then, if its Schedule II, provide the patient with (3) 1-month prescriptions, each with the statement, "do not fill until ".

But I do think that patient should be referred to pain management after some reasonable period of time. Just like we refer to cardiology, nephrology and wound care centers, pain needs a specialist who follows evidence-based practice and knows the pitfalls.

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Do you hold a DEA prescribing license?

If so for acute ER opioid medication is max 15. Private practice you can write up to 240

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casias12 has 30 years experience and specializes in Cardiology nurse practitioner.

101 Posts; 2,879 Profile Views

Do you hold a DEA prescribing license?

If so for acute ER opioid medication is max 15. Private practice you can write up to 240

Not yet. I can get it in January.

15 what? 240 what? That doesn't make any sense.

Each state governs prescribing practice. In Florida, MD's have to write a paper script for up to 30 days at a time for chronic pain management. But, they only have to do a face-to-face every 90 days. So most of them write (3) one month scripts, with each one stating "do not fill until" on the script. Some have the patient come in every month to pick up the script from the desk.

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lhflanurseNP has 40 years experience as a APRN and specializes in Adult Nurse Practitioner.

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If you haven't already done so, please attend one of the many classes that are being held that go over controlled substances for the upcoming changes to the Florida NP scope of practice. Class II can only have a 7 day limit when written by NP or PA. There are also rules about how and when to do controlled drugs.

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I understand.

In Nevada CII drugs can be written for 30 days and Max 240 quantity.

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casias12 has 30 years experience and specializes in Cardiology nurse practitioner.

101 Posts; 2,879 Profile Views

If you haven't already done so, please attend one of the many classes that are being held that go over controlled substances for the upcoming changes to the Florida NP scope of practice. Class II can only have a 7 day limit when written by NP or PA. There are also rules about how and when to do controlled drugs.

Guess you didn't read my first post.

I just went to one. It was total garbage, full of misinformation and not state specific. Total waste of a day and $200.

State-specific rules are, state-specific. That's why I was hoping to find some FL NP's planning to prescribe in Florida who have looked into the laws in-depth.

Quantity 15 or quantity 240.

Hmm. I've never seen a quantity limit in Florida, just the rules that I stated in my previous post.

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casias12 has 30 years experience and specializes in Cardiology nurse practitioner.

101 Posts; 2,879 Profile Views

If you haven't already done so, please attend one of the many classes that are being held that go over controlled substances for the upcoming changes to the Florida NP scope of practice. Class II can only have a 7 day limit when written by NP or PA. There are also rules about how and when to do controlled drugs.

Guess you didn't read my first post.

Quantity 15 or quantity 240.

Hmm. I've never seen a quantity limit in Florida, just the rules that I stated in my previous post.

I understand.

In Nevada CII drugs can be written for 30 days and Max 240 quantity.

Gotcha. Still trying to figure out your first response. You use ER. Does this mean extended realease? If so, acute and extended release don't really go together. And 240 is a butt-load of ER pills for a month. If someone is prescribing ER opioids 8 times a day, they need a visit from the DEA.

What happens with acute pain? Say, for instance, a patient has a fairly large abdominal surgery, hernia repair or something, and goes home to recoup. 15 pills wouldn't even scratch the surface if they are taking hydrocodone 4-5 times a day for a couple of weeks. It's clearly not a chronic pain, so is the limit still 15 pills at a time?

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lhflanurseNP has 40 years experience as a APRN and specializes in Adult Nurse Practitioner.

737 Posts; 17,660 Profile Views

casias12...in Florida we are restricted to a 7 day limit on Class II drugs. While this seems limited...and it is...some states do not allow NPs to write for Class II drugs at all. It never ceases to amaze me the differences in state practice laws...go figure!

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casias12 has 30 years experience and specializes in Cardiology nurse practitioner.

101 Posts; 2,879 Profile Views

casias12...in Florida we are restricted to a 7 day limit on Class II drugs. While this seems limited...and it is...some states do not allow NPs to write for Class II drugs at all. It never ceases to amaze me the differences in state practice laws...go figure!

You really don't want to read my first post, do you. Your like someone who looks up halfway through a meeting and asks a question that was already addressed. Go back to texting or whatever you were doing before you tried to shame me.

First. It's not Class. It's Schedule.

Second. My inquiry is not about schedules of opioids. It is about the use of controlled substances in chronic, non-malignant pain.

So, let's move away from SCHEDULE II drugs, and maybe talk about a very common medication prescribed for the elderly. Tamadol. According the the statute, this can be prescribed for 30 days by NP's in Florida. But that would likely be for chronic, non-malignant pain.

As I pointed out, the worthless education seminar I paid for claimed this was not in our scope. But the statute says otherwise. So, do you prescribe it for an elderly person with chronic joint pain, or not?

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