Bill to let advance-practice registered nurses prescribe controlled substances on their own passes Senate, until now its roadblock

By Melissa Patrick
Kentucky Health News

After years of debate and months of negotiations, a bill to create a path for Kentucky's advanced-practice registered nurses to prescribe controlled substances independently has passed the state Senate and gone to the House on a 30-2-1 vote. 

Senate Bill 94 was the result of a compromise brokered by Sen. Julie Raque Adams, R-Louisville, between the Kentucky Medical Association, which has strongly lobbied against the legidslation for years, and the Kentucky Association of Nurse Practitioners and Nurse Midwives.

Sen. Julie Raque Adams

"I'm sure that you will applaud both of these groups, as I do, for coming together for serious negotiations and for reaching a compromise agreement that will increase access to quality health care across Kentucky and will hopefully lead to other joint efforts between these two critically important health care professions in our state," Adams said in presenting the bill.

KMA said in a statement: "Scope-of-practice issues are always of significant concern to the Kentucky Medical Association, especially when controlled substances are involved. . . . The final product preserves the physician-led, team-based care model, while also maintaining and strengthening the CAPA-CS," which stands for Collaborative Agreement for Prescriptive Authority for Controlled Substances. "This will ensure meaningful collaboration between APRNs and collaborating physicians as well as safeguard public health." 

Kentucky APRNs have been able to prescribe controlled substances since 2006 under a CAPA-CS with a physician. They are allowed to prescribe a 72-hour supply of a Schedule II drug, the highest class of controlled substance that can be prescribed, and SB 94 would not change that.

Under the bill, an APRN who wants to prescribe controlled substances independently must work under a CAPA-CS for four years, undergo a license review by the Kentucky Board of Nursing, maintain a U.S. Drug Enforcement Administration registration and a master account in the Kentucky All-Schedule Prescription Electronic Reporting system.  

Adams said the bill creates "significant improvement in the structure and communication" between APRNs and their collaborating physician by creating a committee made up of APRNs and physicians who will meet at least twoce a year to review an APRN's controlled-substance prescriptions.  

The bill would establish the Controlled Substances Prescribing Council in the Office of the Inspector General at the Cabinet for Health and Family Services, which will meet at least quarterly to discuss the safe and appropriate prescribing and dispensing of controlled substances.

American Assn. of Nurse Practitioners map, adapted by Ky. Health News

“This legislation has been seven years in the making and I am particularly pleased because it included the stakeholders from the beginning,” Adams said in a news release. “We rarely get everything we want in Frankfort, but with SB 94, I believe everyone who came to the table got most of what they wanted.”

In the last legislative session, the House overwhelmingly passed a bill to increase APRN prescriptive authority after a four-year collaborative agreement, but it got nowhere in the Senate.

Republican Floor Leader Damon Thayer of Georgetown said he had opposed the idea for his entire 20 years in the Senate, but supports it now because of the compromise between the KMA and APRNs.  "I hope it works," he said. "I know it's something we're going to be watching very closely."

Senate President Robert Stivers, R-Manchester, said he voted for the bill to increase health-care accres for Kentuckians, but he called for more oversight of the providers who continue to prescribe too many opioids.

The two "no" votes came from Republican Sens. Phillip Wheeler of Pikeville and Donald Douglas of Nicholasville, a physician. Sen. Adrienne Southworth, R-Lawrenceburg, passed. 

Wheeler said he voted no because he was concerned about the potential to increase the prescribing of opioids: "What we do not need to do is to provide another mechanism to provide greater access to pain medications and opioids in rural areas. I mean, if I could restrict the prescribing abilities of doctors more on narcotics and opioids, I would do it here today."

Douglas, a physician, said he was "concerned about the bill" because an APRN's training is not as rigorous as a physician's. He also voiced concerns about what he called "clinical creep." 

Nurse practitioners have up to seven years of education, including post-graduate training. They may prescribe medications, diagnose conditions, order and interpret tests, and deliver general care.

"My only concerns are for those who we deliver the health care to," Douglas said. "My only concern is that they are getting optimal health care, not just good health care or not just health care that's available, but optimal health care."