Can a PMHNP licensed in one state prescribe Adderall (amphetamine and dextroamphetamine) to a patient in another state where they are not licensed?

Interstate Prescribing of Controlled Substances: Licensure Requirements

No, you cannot prescribe Adderall to a patient in another state where you are not licensed—full licensure in the state where the patient is located is required for prescribing controlled substances via telemedicine. 1

Core Licensure Requirements

The fundamental rule is that licensure is required in the state where the patient is receiving the intervention, not where the patient resides. 1 This means:

• If the patient is physically located in a state where you lack licensure when receiving telepsychiatry services, you cannot legally prescribe to them 1
• Full licensure in both states (your state and the patient's state) is usually required when providing cross-state telemedicine services 1
• The requirement applies regardless of whether you are a PMHNP, psychiatrist, or other prescriber 1

Federal Controlled Substance Restrictions

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 technically requires at least one in-person evaluation before prescribing controlled substances (including Adderall) via telemedicine. 1 Key federal considerations include:

• The DEA has stated it does not intend to interfere with legitimate telemedicine prescribing of controlled substances, but has not finalized promised regulations since 2008 1
• The act created exceptions for telemedicine but left provisions incomplete 1
• Several states have enacted their own legislation allowing controlled substance prescribing via telemedicine, but this varies by jurisdiction 1

Limited Exceptions and Alternatives

Some states offer pathways that may not require full licensure, though these are limited: 1

• Limited telemedicine licenses: Several states allow limited licensure specific to providing services through telemedicine, which are usually obtained more quickly than full licenses but have scope restrictions 1
• Neighboring state provisions: A few states allow telepsychiatry services from physicians licensed in neighboring states 1
• Emergency services: Some states allow emergency telepsychiatry services without a license, but with strict regulations on extent and frequency 1
• Interstate Medical Licensure Compact: As of 2017,18 states had adopted this compact to streamline multi-state licensure, with additional states introducing legislation 1

Critical Action Steps Before Prescribing

Before initiating any telepsychiatry services involving controlled substances, you must: 1

• Consult your state's medical board guidelines and laws 1
• Consult the patient's state medical board guidelines and laws 1
• Review DEA regulations, particularly the Office of Diversion Control guidelines regarding telemedicine 1
• Verify your professional liability and malpractice insurance covers telepsychiatry services and may require notification of services provided through telemedicine 1
• Determine if your state participates in the Interstate Medical Licensure Compact 1

Common Pitfalls to Avoid

Do not assume that:

• Consultation between providers exempts you from licensure requirements—while most states allow physician-to-physician consultations without reciprocal licensure, some states require the consultant to be licensed where the patient is located 1
• Temporary or emergency provisions apply to routine ADHD management—emergency exceptions are typically limited in scope and frequency 1
• Federal telemedicine flexibilities during COVID-19 remain in effect—verify current regulations as these have evolved 1

Practical Recommendation

The safest and most legally compliant approach is to obtain full licensure in the patient's state before prescribing Adderall or any controlled substance. 1 If this is not feasible, refer the patient to a licensed provider in their state or explore whether your states have reciprocal telemedicine agreements or compact participation that would expedite licensure. 1