What schedule narcotics can nurse practitioners (NPs) prescribe in Georgia (GA)?

Nurse Practitioner Prescribing Authority for Controlled Substances in Georgia

In Georgia, nurse practitioners can prescribe Schedule III, IV, and V controlled substances but cannot prescribe Schedule II controlled substances without physician delegation.

Prescribing Authority for Nurse Practitioners in Georgia

• Nurse practitioners in Georgia can prescribe Schedule III controlled substances such as combination products containing hydrocodone (15 mg or less) with acetaminophen or ibuprofen, and codeine combination products 1
• NPs cannot independently prescribe Schedule II controlled substances in Georgia, which include morphine, oxymorphone, oxycodone, hydromorphone, and fentanyl 1
• Prescribing authority for NPs in Georgia requires physician delegation through a protocol agreement 2

Schedule Classifications and Examples

Schedule II (NPs Cannot Prescribe Independently in GA)

• Morphine (e.g., MS Contin) 1
• Oxycodone and oxycodone combination products (e.g., Roxicodone, Percocet) 1
• Hydromorphone (e.g., Dilaudid) 1
• Fentanyl (e.g., Duragesic patch) 1
• Methadone 1

Schedule III (NPs Can Prescribe in GA)

• Hydrocodone combination products with acetaminophen (e.g., Vicodin, Lortab) 1
• Hydrocodone combination products with ibuprofen (e.g., Vicoprofen) 1
• Codeine combination products 1
• Buprenorphine (with limitations) 1

Schedule IV and V (NPs Can Prescribe in GA)

• Benzodiazepines 1
• Tramadol 1
• Pregabalin 1
• Low-dose codeine preparations 1

Important Considerations for NP Prescribing

• When prescribing opioids, NPs should use the lowest effective dose for the shortest duration consistent with treatment goals 3
• For acute pain, immediate-release opioids should be prescribed rather than extended-release/long-acting opioids 1
• NPs should avoid prescribing opioids as first-line therapy for many common acute pain conditions including low back pain, neck pain, and headaches 1
• When prescribing hydrocodone-acetaminophen, recommend "as needed" dosing rather than scheduled dosing (e.g., one tablet not more frequently than every 4 hours as needed for moderate to severe pain) 3

Buprenorphine Prescribing Considerations

• NPs in Georgia can prescribe buprenorphine for opioid use disorder but must obtain a federal waiver (X-waiver) 4
• For administering buprenorphine in emergency settings for opioid withdrawal, any DEA-licensed provider may administer (but not prescribe) for up to 72 hours while arranging referral for treatment 1

Prescribing Pitfalls to Avoid

• Avoid prescribing long-acting or extended-release Schedule II products such as oxycodone ER (OxyContin), methadone, or fentanyl patches for acute pain 1
• Avoid prescribing meperidine (Demerol) for chronic pain, especially in patients with impaired renal function, due to risk of neurotoxicity 1
• Avoid concomitant prescribing of opioids with benzodiazepines when possible, as this increases overdose risk 1
• Be aware that studies show NPs are generally less likely to prescribe opioids compared to physicians, but when they do prescribe, they may be more likely to prescribe higher doses 5

State-Specific Regulatory Considerations

• Georgia's scope of practice laws require physician supervision for NP prescribing of controlled substances 6
• NPs should be aware that state regulations can change and should stay updated on current prescribing laws 2
• Some states have additional requirements beyond general scope of practice laws specifically for buprenorphine prescribing 4

Remember that while NPs in Georgia can prescribe Schedule III-V controlled substances, they must do so under physician delegation through protocol agreements, and they cannot independently prescribe Schedule II controlled substances.