From the Guidelines
Yes, in Colorado, Advanced Practice Registered Nurses (APRNs) are permitted to prescribe medications, including controlled substances, via telehealth, provided they comply with the state's Prescription Drug Monitoring Program and federal rules such as the Ryan Haight Act. To do so legally, APRNs must comply with Colorado's Prescription Drug Monitoring Program (PDMP) requirements, which include checking the database before prescribing certain controlled substances, as noted in the most recent guidelines 1. They must also adhere to federal regulations such as the Ryan Haight Act, which generally requires an in-person examination before prescribing controlled substances, though there are exceptions during the COVID-19 public health emergency. APRNs in Colorado must have a valid DEA registration, maintain an active nursing license, and have prescriptive authority granted by the Colorado Board of Nursing. When prescribing via telehealth, APRNs should establish a proper provider-patient relationship, conduct appropriate assessments, document thoroughly, and follow up as needed. This telehealth prescribing authority helps increase access to healthcare, particularly in rural areas of Colorado where in-person medical care may be limited, while still maintaining appropriate safeguards for controlled substance prescribing.
Some key considerations for APRNs prescribing via telehealth include:
- Ensuring compliance with federal and state regulations, including the Ryan Haight Act and Colorado's PDMP requirements 1
- Establishing a valid provider-patient relationship through real-time audiovisual technology 1
- Conducting appropriate assessments and documenting thoroughly 1
- Maintaining patient confidentiality and adhering to HIPAA regulations 1
- Staying up to date on changes in regulations and policies, such as those related to the COVID-19 public health emergency 1
By following these guidelines and regulations, APRNs in Colorado can provide safe and effective telehealth services, including prescribing medications and controlled substances, to patients in need.
From the Research
Opioid Prescription in Colorado via Telehealth
- In Colorado, APRNs are permitted to prescribe medications, including controlled substances, via telehealth, provided they comply with the state’s Prescription Drug Monitoring Program and federal rules such as the Ryan Haight Act.
- The prescription of opioids for chronic non-cancer pain is a complex issue, with studies suggesting that opioids can be effective for pain relief, but also carry significant risks of side effects and addiction 2, 3.
- A study published in 2008 found that many patients in the included studies were dissatisfied with adverse events or insufficient pain relief from opioids and withdrew from the studies 2.
- Another study published in 2006 found that opioids were more effective than placebo for both pain and functional outcomes in patients with nociceptive or neuropathic pain or fibromyalgia, but also found that strong opioids were associated with more side effects than weak opioids 3.
Evidence for Opioid Therapy
- A 2020 study suggested that opioid therapy may be appropriate for chronic pain management in certain patients, particularly those with severe pain that is unresponsive to other therapies 4.
- A systematic review and meta-regression of observational studies published in 2020 found that approximately 30.7% of patients with chronic noncancer pain were prescribed an opioid, with strong opioids being more frequently prescribed than weak opioids 5.
- A 2013 study discussed the importance of safe prescribing practices for opioids, particularly in older adult patients who are at higher risk for NSAID-related adverse effects 6.