House passes bill to allow APRNs to prescribe controlled substances after a four-year collaborative agreement with doctor

Rep. Russell Webber

Webber was alluding to the implicit contention of the doctors’ lobby, the Kentucky Medical Association, that APRNs haven’t been responsible enough with their prescribing of Schedule II drugs, those with high potential for abuse, to prescribe them independently.
In Kentucky, APRNs have been able to prescribe controlled substances since 2006 under a “collaborative agreement for prescriptive authority-controlled substances,” or CAPA-CS. They are allowed to prescribe a 72-hour supply of a Schedule II drug; HB 354 wouldn’t change that.

The bill’s primary co-sponsor, Rep. Patti Minter, a Democrat from Bowling Green, told the House that it is needed to increase health-care access in a state that has only 57 percent of the primary-care practitioners it needs and 25% of needed mental-health personnel.

Rep. Jerry Miller, R-Eastwood, said the bill would improve access to health care. “This is a good bill for the people,” he said. “It may not be a good bill for the doctors, but it’s a good bill for the people of Kentucky.”

House health committee Chair Kim Moser, R-Taylor Mill, a former nurse and a doctor’s wife, voted no. Moser said she liked the amendments because “It’s critical that all prescribers play by the same rules” but cautioned, “The only thing that we are doing by passing this bill is increasing controlled substances.”

The House voted against suspending its rules to let Moser offer a floor amendment to reinstate the requirement that an APRN be licensed to practice for a year before being prescribing controlled substances, to obtain a registration certificate from the Drug Enforcement Administration and pass each component of the federal licensing exam in three attempts, just as physicians must do before prescribing controlled substances.

Rep. Mary Lou Marzian, D-Louisville, a nurse, said the bill is needed because APRNs need a DEA number to order some diabetic and psychiatric medication, durable medical equipment, and flu and antibiotic shots.

APRNs were allowed to prescribe controlled substances without a collaborative agreement in the pandemic through an executive order that the General Assembly approved, but that ended in January when lawmakers extended the state of emergency but did not extend the APRNs’ expanded authority.

Dueling numbers

A before-and-after comparison by the Kentucky Association of Nurse Practitioners & Nurse-Midwives, said there were “no significant differences in the average number of opioid prescriptions by APRNs without the CAPA-CS in place” before the emergency order was implemented and the seven quarters it was in place. Similar findings were also noted for dentists and physicians.

The data came from the state’s Kentucky All Schedule Prescription Electronic Reporting system. Other KASPER data provided by the APRN association shows that the average number of Schedule II prescriptions per APRN prescriber dropped 34.9% between 2015 and 2021.

Webber said, “Nurse practitioners were not writing prescriptions hand over fist for controlled substances and flooding the state with opioids.”

The KMA disputed those figures before the House Licensing, Occupations and Administrative Regulations Committee on March 9.

Cory Meadows, KMA’s deputy executive vice president and director of advocacy, said “We have KASPER numbers that show that they are consistently up, way up over the course of a lot of years.”

KASPER data provided by the KMA, comparing the total number of prescriptions for Schedule II opioids prescribed by APRNs shows an increase in all but one year since since 2011, the year before lawmakers passed what is called the “pill-mill bill” that placed restrictions on opioid prescribing.