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Alabama: Controlled Substance Prescribing Still Out of Reach

A bill that would have granted controlled substance (CS) prescribing authority to Alabama NPs died in the House due to disagreement between the Nurse Practitioner Alliance of Alabama (NPAA) and the Medical Association of the State of Alabama (MASA). NPAA disagrees with MASA requests that prescribing authority be controlled by the state Board of Medical Examiners, not the Board of Nursing (BON).

National data support the BON as a single certifying body that regulates nurses, said Lori Lioce, NP, president of NPAA. She added that control of one profession over another is not appropriate. "It sets the professions up for conflict and failure and does not create the best evidence-based patient-centered care!" NPs in Alabama have been prescribing medications since 1996, but still have not gained CS prescribing authority. Alabama and Florida are the only two states where NPs don't have this authority.

"Nurses have not been in the business of prescribing controlled substances," said Mark Jackson, MASA's legislative affairs director, in The Huntsville Times. "Wake up," Lioce said, "... medical care has always been provided as an interdisciplinary team." NPAA's goal is to provide what's best for the patient, and many are in pain longer than necessary because they have to wait or make another appointment for a prescription. Alabama NPs work under statutory collaboration with physicians, who must sign off on all controlled substance prescriptions.

Lioce said that a recent study found Alabama nurse practitioners waste 4 hours a week getting prescription orders through physicians. She also said that many of the state's NPs have given up and moved on to states that will allow them to practice to the scope of their education.

"The barriers to practicing here are just unreal," Lioce told The Huntsville Times. The NPAA plans to renew the fight for CS prescribing rights in 2010.

News You Can Use Archives

I cannot find the Coffey Study online. How can I find this study? Thank you!

Karen ,  ARNPSeptember 01, 2010

How can it be that 48 (yes, that is forty eight) other states have given prescriptive authority to their NP's and Alabama and Florida are still lagging behind. Somehow this looks backward for our states. With other states using these professionals to their fullest I believe there is enough evidence for everyone to evaluate their safety and value as primary care providers as well as the track record of NPs prescribing narcotics. Let's wake up and join the rest of the country so that we can provide timely quality care to clients here in Alabama!

Barbara  Naman,  CRNP,  MCHDAugust 16, 2010

Just a few points of clarification:
The Coffey Study was completed in Florida by Stephanie Coffey in 2009-10 and found that in a week approximately 4 hours per NP was wasted trying to get physician signatures for controlled substance prescriptions. This was significant because it translates to 8 patient visits per week and hundreds of thousands lost visits per year in the state. With a significant shortage of primary care providers it is easy to see how NPs could be used to increase access to care if restrictive collaboration and barriers were decreased.
Further, NPs and PAs have been implemented into healthcare in all arenas at this point in the US. Health care teams have extended care to overcome barriers and in many states are the first line providers who help patients access the system earlier often preventing chronic health issues.
Prescribing controlled substances is not a business. It is a responsibility for health care providers, with more paperwork and follow required, but it is most importantly a right of the patient to safe effective quality care. Care that does not prolong their pain (which impedes healing). It will not serve the best interest of the patient if NPs are primary and acute care access points to the healthcare system if they are left in pain longer than necessary.
Alabama requires collaborative practice between NPs and physicians. Restrictive collaboration is not delivering optimal care, increasing vital access in the rural areas, or promoting interdisciplinary trust. Truthfully, restrictive collaboration has increased barriers, decreased autonomy, driven NPs across state lines, and disenfranchised nurses in Alabama who have been advocating for their patients. Additionally, barriers to practice are wasting taxpayers educational monies to train healthcare providers for Alabama that ultimately leave the state to provide the care they are nationally certified to provide to adequately care for the patient.
Physicians in collaborative agreements could easily remedy the situation by advocating for their patients and standing up to their own lobbyist (instead of providing dues that fund the lobbyist. Less than 17% of physicians participate in the decision making of their state professional organization. Only a fraction of these even understand NPs national scope of practice. Further the medical organizations continue to distribute misinformation to the physicians--utilizing fear tactics on their own physicians. Again this year MASA told Alabama physicians that NPs tried to eliminate collaborative practice. Independent practice was never discussed this session. Physicians in collaborative practice must believe NPs provide safe effective care or they wouldn't hire them to take care of the patients. They support NPs in private, just imagine if we lived in a world where they would publicly advocate for all health care professionals to have the right to practice to their full scope of board certified professional practice. Practice barriers would be removed quickly and patients would begin receiving more comprehensive, holistic, care, saving thousands of healthcare dollars. The world just might be a better place. I know Alabama would.

Lori Lioce, CRNP,  Dr. ,  Huntsville Hospital/UA HuntsvilleAugust 16, 2010
Huntsville, AL


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