ARNPs in Washington State Can Prescribe 90-Day Supplies of Stimulants
As an ARNP PMHNP in Washington state, you are allowed to prescribe a 90-day supply of stimulants. While stimulants are Schedule II controlled substances, Washington state regulations permit advanced practice nurses with prescriptive authority to write prescriptions for up to a 90-day supply.
Prescribing Authority for ARNPs in Washington State
ARNPs with prescriptive authority in Washington state have full prescribing privileges for controlled substances, including Schedule II medications like stimulants. This allows you to:
- Prescribe a full 90-day supply of stimulant medications
- Write prescriptions that align with best practices for medication management
- Provide appropriate coverage for patients with stable, chronic conditions like ADHD
Best Practices When Prescribing 90-Day Supplies
When prescribing a 90-day supply of stimulants, consider implementing these safeguards:
- Patient Selection: Reserve 90-day prescriptions for stable patients who have demonstrated medication adherence and appropriate use
- Regular Monitoring: Even with 90-day prescriptions, maintain appropriate monitoring intervals
- Documentation: Clearly document the rationale for 90-day prescriptions in the patient's chart
- Vital Sign Monitoring: For adults on stimulants, blood pressure and pulse should be checked quarterly 1
Medication Management Considerations
The American Academy of Child and Adolescent Psychiatry guidelines note that while stimulants require Schedule II prescriptions with no refills, practitioners can:
- "Fill out prescriptions on a monthly basis, and sometimes once every 3 months" 1
- See stable patients with uncomplicated presentations "once every 3 or 4 months" 1
Common Stimulant Options
When prescribing stimulants for a 90-day supply, consider these common options:
- Methylphenidate (Ritalin, Concerta): Starting doses typically 5mg, with maximum daily doses generally not exceeding 60mg 1
- Amphetamine mixed salts (Adderall): Starting doses typically 10mg, with titration by 5mg weekly up to 50mg 1
- Lisdexamfetamine (Vyvanse): Starting doses 20-30mg, with increases of 10mg weekly to maximum of 70mg 1
Caution Areas
When prescribing 90-day supplies, be mindful of:
- Risk of Diversion: Implement appropriate safeguards if there is concern about medication misuse
- Contraindications: Avoid stimulants in patients with psychosis, glaucoma, or those taking MAO inhibitors 1
- Monitoring Requirements: Ensure patients understand the importance of follow-up visits despite having a longer medication supply
By following these guidelines, you can appropriately prescribe 90-day supplies of stimulants as an ARNP PMHNP in Washington state while maintaining safe and effective patient care.