From the Guidelines
In Colorado, Advanced Practice Registered Nurses (APRNs) are indeed permitted to prescribe medications, including controlled substances, through telehealth services, as long as they comply with the state's Prescription Drug Monitoring Program and federal rules such as the Ryan Haight Act, as noted in the most recent guidelines 1. This permission is crucial for increasing healthcare access, particularly in rural or underserved areas of Colorado. To prescribe via telehealth, APRNs must:
- Comply with Colorado's Prescription Drug Monitoring Program (PDMP) requirements, which include checking the database before prescribing certain controlled substances.
- Adhere to federal regulations like the Ryan Haight Act, which generally requires an in-person examination before prescribing controlled substances, though there are exceptions for telemedicine in certain circumstances.
- Maintain appropriate licensure and have a DEA registration to prescribe controlled substances.
- Follow standard of care practices when prescribing remotely, including conducting thorough patient assessments, documenting the clinical reasoning for prescriptions, and ensuring appropriate follow-up care. The authorization for APRNs to prescribe via telehealth helps maintain appropriate safeguards for patient safety through regulatory compliance and professional standards of practice, as emphasized in recent studies 1. Key considerations for APRNs prescribing via telehealth include:
- Ensuring compliance with state and federal regulations.
- Maintaining patient privacy and security in accordance with HIPAA guidelines.
- Documenting patient interactions and prescriptions thoroughly.
- Staying updated on changes in regulations and policies, such as those related to the COVID-19 pandemic, which may temporarily alter the requirements for prescribing controlled substances via telehealth 1.
From the Research
Overview of APRN Prescribing in Colorado
- In Colorado, Advanced Practice Registered Nurses (APRNs) are allowed to prescribe medications, including controlled substances, via telehealth, as long as they comply with the state's Prescription Drug Monitoring Program and federal rules such as the Ryan Haight Act.
Guidelines for Opioid Prescription
- The American Society of Interventional Pain Physicians (ASIPP) has developed guidelines for the responsible prescription of opioids for chronic non-cancer pain, which include comprehensive assessment and documentation, screening for opioid abuse, and utilization of prescription drug monitoring programs (PDMPs) and urine drug testing (UDT) 2.
- These guidelines aim to reduce the abuse and diversion of opioids while ensuring access to appropriate medical care for patients with chronic non-cancer pain.
Prevalence of Opioid Abuse and Illicit Drug Use
- Studies have shown that opioid abuse and illicit drug use are common among chronic pain patients, with a prevalence of 9% and 16%, respectively 3.
- Risk factors for opioid abuse and illicit drug use include age, pain after motor vehicle accident, involvement of multiple regions, and past history of illicit drug use.
Integrative Therapeutic Approach
- An integrative therapeutic approach is recommended to manage chronic pain and addiction, taking into account the complex interactions between pain, psychosocial dysfunctions, medical and psychiatric disorders, polypharmacy, and polysubstance use 4.
- This approach recognizes that chronic pain and addiction are often intertwined and require a comprehensive treatment plan that addresses multiple aspects of the patient's condition.