Can physician assistants (PAs) in the state of [STATE] write Schedule 2 prescriptions, such as Adderall (amphetamine and dextroamphetamine), for patients?

Physician Assistant Schedule II Prescribing Authority

Direct Answer

The ability of physician assistants to prescribe Schedule II controlled substances, including Adderall (amphetamine-dextroamphetamine), varies by state law, with 73% of states (37 out of 50) allowing PAs to prescribe Schedule II medications as of 2015. 1 Without knowing the specific state in question, I cannot provide a definitive answer, but the majority of states do grant this authority.

State-by-State Variation in PA Prescriptive Authority

Schedule II Prescribing Rights

• 37 states (73%) permit PAs to prescribe Schedule II controlled substances, which includes stimulants like Adderall, opioids like oxycodone, and other high-abuse-potential medications 1
• All states except Florida and Kentucky allow PA prescribing of Schedule III-V medications, demonstrating broad acceptance of PA prescriptive authority for lower-schedule controlled substances 1
• Schedule II substances include morphine, oxymorphone, oxycodone, hydromorphone, fentanyl, and amphetamines like Adderall 2

Geographic Patterns in Prescribing Authority

• Larger-population states are more likely to grant expanded prescriptive authority to PAs, including Schedule II prescribing privileges 1
• Rural states tend to have fewer restrictions on PA practice scope, recognizing the critical role PAs play in addressing provider shortages in underserved areas 1
• States with higher PA-to-population ratios demonstrate greater comfort with expanded PA practice authority 1

Regulatory Framework for Schedule II Substances

DEA Classification Requirements

• Schedule II substances are defined by high abuse potential but accepted medical use under strict supervision, as established by the Comprehensive Drug Abuse Prevention and Control Act of 1970 2
• Schedule II prescriptions require the most stringent documentation, including specification of total quantity, number of days, strength, dose, and frequency 2
• Adderall is classified as a DEA Schedule II controlled substance with high potential for abuse 3

Prescription Monitoring Programs

• Prescription drug monitoring programs (PDMPs) track Schedule II through IV controlled substances in 41 states to identify diversion and doctor shopping 2
• PDMPs allow healthcare providers and pharmacists to access patient prescription histories for patients under their care 2
• Implementation of PDMPs was associated with a 30% reduction in Schedule II opioid prescribing rates across 24 states 4

Clinical Practice Patterns Among PAs

Current Prescribing Behavior

• PAs prescribe controlled substances at higher rates than physicians or nurse practitioners (19.5% vs 12.4% and 10.9% respectively), particularly in primary care settings 5
• PAs write prescriptions for 60-70% of all patient visits, with a mean of 1.3-1.5 prescriptions per visit 5
• In rural areas specifically, prescribing patterns differ, with PAs writing significantly fewer total prescriptions than NPs or physicians 5

Supervision and Oversight Requirements

• Only 6 states (12%) require physician review of medical records within 1 week of a PA-only patient encounter, indicating broad autonomy in most jurisdictions 1
• Virginia explicitly requires onsite physician presence for PA practice in emergency departments, representing the most restrictive supervision model 1
• Most states allow PAs to practice with limited direct supervision, particularly in emergency and rural settings 1

Common Pitfalls and Caveats

State-Specific Verification Required

• Always verify current state law before assuming prescriptive authority, as regulations change frequently and vary significantly between jurisdictions 1
• Some states that allow Schedule II prescribing may impose quantity limits, duration restrictions, or require specific training or collaborative agreements 1
• Federal DEA registration is required in addition to state authorization for any controlled substance prescribing 2

Documentation and Monitoring Obligations

• Check the state PDMP before prescribing any Schedule II medication to identify potential diversion, doctor shopping, or concurrent prescriptions from multiple providers 4, 2
• Maintain detailed records including indication, dose, duration, and patient education about abuse potential and diversion risks 2
• For Adderall specifically, document ADHD diagnosis or narcolepsy indication, as these are the only FDA-approved uses 3

Special Considerations for Stimulant Prescribing

• Monitor cardiovascular parameters including blood pressure and heart rate at each visit, particularly during dose titration of amphetamine products 6
• Counsel patients to limit caffeine intake to less than 200mg daily when taking amphetamines to minimize cardiovascular risks 6, 7
• Watch for signs of diversion, misuse, or off-label use for cognitive enhancement, which is common among college students 3