Should NP able to prescribe narcotics?

futureeastcoastNP · Jan 23, 2014

Physicians are against NPs prescribing narcotics because the more they can restrict NPs from doing, the less patients they lose. It's nothing more than another tool in the turf war orificenal designed to protect the high salary of MDs at the expense of patient access.

Why should NPs be able to prescribe? Because they serve patients who might need them. There are many NPs providing critical access to people who would otherwise have none, and sometimes those patients might need narcotics. Is it fair to make a poor Medicaid patient in horrible pain wait 2 months for an appointment to drive 3 hours to the nearest MD staffed Medicaid clinic to pick up a few hydrocodone? All so the MDs can make their next mercedes payment? I think not. NPs are more than qualified to write the prescription themselves, and they do so in numerous states without the chicken little disaster scenario that physicians act like it will create.

Advanced Practice Columnist / Guide · Jan 23, 2014

It's a silly argument. There are far more medications out there with serious considerations and huge risks vs benefit ratios that the medical community doesn't make a big deal of and they are not narcotics. Does that mean it's OK for NP's to prescribe those? Are NP's viewed on the same level as low-life drug pushers that can't be trusted to prescribe narcotics? It is utterly ridiculous if you look at it closely.

babyNP., APRN · Jan 23, 2014

Yes, they should. If I'm the only provider on staff on a night shift in a NICU my infant comes back post-op in the middle of the night from necrotizing enterocolitis, it's cruel and unusual to not allow them pain relief.

This issue is a total non-brainer.

Trauma Columnist · Jan 24, 2014

Most of us already do so, whats the argument since its already an accomplished fact.

BlueDevil,DNP, DNP, RN · Jan 24, 2014

How is this even a suitable question for debate in a NP program? It's offensive.

TashaLPN2006RN2012, ASN, RN · Jan 24, 2014

FL is one of the restrictive states that do not allow Narc's to be prescribed by NP's. It's an argument I even had with my medical director (lovingly done of course) and even he (an MD) agreed that the benefits of allowing an NP to control a pt's pain far out weighed the need to restrict...sad their are still states that enforce this rule!

Trauma Columnist · Jan 25, 2014

Wow! I guess IL is pretty forward-thinking!!

ixchel · Jan 25, 2014

Interestingly enough, I don't think I've ever heard of an NP being put in the news for over prescribing opioids. I've heard of several MDs doing it though. My mind gets blown when these stories come out on medscape. The volume of meds these MDs are prescribing makes you wonder if they're writing scripts to people who turn around and sell them.

But, I digress....

Ever since I turned spinal fractures into a grade 2 spondylolisthesis in an unfortunate roller stating accident, my pain has been managed by NPs who have been doing so much more than asking me to rate my pain and hand me a script. They discuss my life and how I balance pain, school, kids, meds, and basically, my sanity. The training of NPs to give holistic care makes them the BEST candidates for prescribing controlled medications. (In my opinion, which is based on experience as a patient.)

barefoot_girl · Jan 25, 2014

I am an FNP and I work for a large regional oncology group as the hospital-based NP. Nothing could have prepared me for the types or severity of pain my patients experience.

I recently cared for a 43 year old just diagnosed with metastatic pancreatic adenocarcinoma. She had been diagnosed in a small, rural hospital. Discharged home to be brought to her parents home in a larger, metropolitan city. The first hospital had stopped her iv pain meds and sent her out for a three hour drive with some po meds. Only problem was her esophageal obstruction. I started her with dilaudid 2 mg IV and left that night with a PCA pump using a 4 mg basal and 2 mg q10. I sent her for celiac plexus block that failed because her tumor was growing in and thru the plexus. I tried sending her home with hospice at 50 mg basal and 10 mg q10 but her pain continued to accelerate. After three days she was back in the hospital and we started mixing liter bags of dilaudid and using iv pumps because we were burning thru the pca vials in less than an hour. She was exceeding 150 mg hourly and beginning to have spasms so I added an ativan drip of 4 mg an hour. I moved the dilaudid back and added to the dilaudid and ativan a methadone drip.

I had never imagined prescribing these types and volumes of narcotics but neither had I ever anticipated such a horrific disease process. She was the second patient in as many months to require these massive doses of drugs - the other girl was only 27. Neither of these young women exceeded 60 kg and neither had any history of drug or alcohol addiction or abuse.

I share these two instances because had there not been someone there with these patients, throughout the day, who was able to prescribe and adjust doses on these drugs these women would likely have suffered even more than they did. The ED doctors had given each of them dilaudid 0.5 mg IV q3-4 hours. Like spitting into the wind.

So, yes, I firmly believe nurse practitioners should be entrusted with prescriptive authority including narcotics of any flavor. If you are careless with prescribing you might injure someone just as mortally giving them digoxin.

I have heard the arguments that NPs are not qualified and I wonder if the skepticism is rooted in our training and qualifications or something else.

allnurses Guide · Jan 25, 2014

I don't know if you are still managing that patient but try a celiac plexus block and if that is effective a tertiary center can put in an IT pump, I've had two similar patients then went to 0/10 pain with no oral meds.

futureeastcoastNP · Jan 25, 2014

I don't know if you are still managing that patient but try a celiac plexus block and if that is effective a tertiary center can put in an IT pump, I've had two similar patients then went to 0/10 pain with no oral meds.

She said she tried that in the first post and it didn't work.