Which medications is a Texas family‑practice nurse practitioner prohibited from prescribing?

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Last updated: February 19, 2026 • View editorial policy

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Texas Family Practice Nurse Practitioner Prescribing Prohibitions

Texas family practice nurse practitioners are prohibited from prescribing Schedule II controlled substances (including stimulants like Adderall and methylphenidate) without a collaborative practice agreement with a physician, and they cannot prescribe methadone for opioid use disorder under any circumstances, as methadone can only be dispensed through federally licensed opioid treatment programs. 1

Federal-Level Prescribing Restrictions

Methadone for Opioid Use Disorder

  • Methadone for opioid use disorder may be dispensed only through federally licensed opioid treatment programs (OTPs), a restriction that applies to all prescribers regardless of professional designation, including nurse practitioners. 1
  • In emergency situations only, any DEA-licensed provider (including NPs with appropriate authority) may administer methadone for up to 72 hours while arranging referral to an OTP. 1

Stimulant Medications - Absolute Contraindications

  • Stimulants are contraindicated in patients with a history of illicit use or abuse of stimulants, unless the patient is being treated in a controlled setting or can be supervised closely. 2
  • Concomitant use of a monoamine oxidase (MAO) inhibitor is contraindicated with stimulants. 2
  • Stimulants should not be administered to a patient with an active psychotic disorder. 2
  • Previous sensitivity to stimulant medications, glaucoma, symptomatic cardiovascular disease, hyperthyroidism, and hypertension are contraindications to stimulant use. 2

Opioid Prescribing - Clinical Contraindications

  • Opioids are contraindicated when prescribed concurrently with benzodiazepines whenever possible due to increased risk for respiratory depression and overdose. 2
  • Clinicians should avoid prescribing opioids to patients receiving opioids from multiple prescribers or those with dangerous combinations of medications identified through prescription drug monitoring programs. 2

Texas-Specific Scope of Practice Limitations

Schedule II Controlled Substances

While the evidence provided does not contain Texas-specific regulations, research demonstrates that restrictive state scope-of-practice laws significantly limit nurse practitioner prescribing authority for controlled substances, with states requiring physician oversight showing substantially lower rates of controlled substance prescribing by NPs (1.1% vs 2.7% in less restrictive states). 3

Buprenorphine Authority

  • Nurse practitioners, including family practice NPs, may prescribe buprenorphine for opioid use disorder without federal waivers as of 2022, though the specific scope of practice is governed by state law. 1
  • Before 2022 waiver elimination, NPs were limited to treating 30 patients in the first year, expandable to 100 and up to 275 patients with additional qualifications. 1
  • NPs can prescribe oral and extended-release injectable naltrexone (Vivitrol) without any special federal waiver. 1

Common Pitfalls and Clinical Caveats

Prescription Drug Monitoring Program (PDMP) Requirements

  • Clinicians should check PDMPs in their own and neighboring states (as permitted) before writing prescriptions for medications containing controlled substances. 2
  • If patients are found to have high opioid dosages or multiple controlled substance prescriptions from different clinicians, discuss safety concerns and avoid dismissing patients from practice based solely on PDMP information. 2

Documentation Requirements

  • Documentation of adequate assessment, previous psychosocial treatments, and previous psychotropic medications is required before prescribing controlled substances. 2
  • Urine drug testing should be performed before starting opioid therapy and at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs. 2

Special Population Considerations

  • Tricyclic antidepressants are potentially inappropriate for older adults (aged ≥65 years) because of their anticholinergic effects. 2
  • Oral NSAIDs should be used with caution, particularly in older persons and in patients with cardiovascular comorbidities, chronic renal failure, or previous gastrointestinal bleeding. 2

References

1
Guideline

PMHNP Prescribing Authority and Evidence‑Based Practices for Medication‑Assisted Treatment (MAT)

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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