Texas Specific Guidelines for Prescribing Controlled Substances

Introduction

The opioid epidemic is a severe problem affecting individuals of diverse populations nationwide; thus, state boards created voluntary guidelines to regulate treating acute and chronic non-cancer pain. In Texas, the Administrative Code contains chapters for medical workers to use in their decision-making (Texas Office of The Secretary of State, n. d.). This paper aims to discuss the Texas opioid use guidelines, the related laws for nurse practitioners, Prescription Monitoring Program, and the Durable Medical Equipment (DME) ordering conditions.

Texas Administrative Code Pain Management Requirements

Texas Administrative Code (TAC) is a document that combines all the state agency rules outlined by the diverse boards. The Medical Board is responsible for the pain management requirements for treating acute and chronic non-cancer pain. As a part of TAC, the guideline is located at the Code’s governmental website texreg.sos.state.tx.us. The minimum standards for pain treatment were developed based on the local situation and prevalent diseases, including opioid use, and addressing Section 481.0764 of the Texas Health and Safety Code (Texas Office of The Secretary of State, n. d.). Furthermore, the guidelines are included in the state’s Boards of Pharmacy and Nursing to outline the prescription regulations and identify practitioners’ responsibilities.

The use of opioids is an appropriate pain management practice for chronic conditions that disrupt an individual’s life with unbearable discomfort. The prescription may also be relevant if the acute pain appears frequently, yet the practitioner must evaluate all the risks and think of alternatives before deciding to use strong substances (Centers for Disease Control and Prevention [CDC], 2021. CDC (2021) states that “clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation” (p. 2). The prescription duration also significantly depends on the individual conditions and should be controlled and adjusted to avoid addiction development.

Texas Laws on Controlled Substance Prescription

The laws on advanced practice nurses’ (APRNs) prescription rights are included in TAC as part of Texas Board of Nursing regulations. Indeed, Texas Administrative Code’s chapter 222 (2019) states that “APRNs with full licensure and a valid prescription authorization number are eligible to obtain authority to order and prescribe certain categories of controlled substances” (§222.8). The law outlines the criteria for controlled substances in Schedules III through V prescription, its 90 days supply, and the prohibition for children under two years of age without a physician’s consultancy (Texas Administrative Code [TAC], 2019). It also limits the Schedule II drugs use limit by emergency and hospital facility-based practice. The chapter does not address specific regulations for treating acute or chronic pain because it uses the general Schedule to group the substances.

Texas Prescription Monitoring Program

Specific requirements for APRNs in Texas include working with a prescription drug monitoring database. The TAC describes the state’s Prescription Monitoring Program (PMP) and requires the practitioners to access the base before prescribing opioids, benzodiazepines, barbiturates, or carisoprodol to patients with non-cancer chronic conditions (TAC, 2019). The PMP is located on the state’s Board of Pharmacy official website at pharmacy.texas.gov/pmp/. The database and program’s dashboard are at texas.pmpaware.net/ where an APRN can register and access the information; the approval of the prescription request is convenient and commonly takes one business day.

Texas Medical Devices Prescribing

Medical device prescription authority for APRNs is also addressed in TAC as the state’s Board of Nursing establishes the regulations. Practitioners without drug-related licensure cannot assign devices or Durable Medical Equipment (DME). Indeed, chapter 222 of TAC suggests that drugs and devices have equal minimum standards for prescribing (TAC, 2021). Such conditions have significant limits for APRNs as patients might need a device urgently, and physician’s consultancy might be unavailable. The DME ordering conditions must also meet the delegation requirements as Texas has no full practice authority.

Conclusion

Although APRNs do not have full practice authority in Texas, there are broad drug prescription options for Schedule I-V substances. The TAC is the main document with the rules developed by the Boards of Nursing and Pharmacy, where the current regulations can be found. Texas government regulates opioid prescription through a special database and enables the practitioners to register their orders and consult with physicians in certain cases.

References

Centers for Disease Control and Prevention. (2021). About CDC’s opioid prescribing guideline.

Texas Administrative Code. (2019). §222.8: Authority to Order and Prescribe Controlled Substances. 

Texas Administrative Code. (2021). §222.4: Minimum standards for prescribing or ordering drugs and devices.

Texas Office of The Secretary of State. (n. d.). Texas Administrative Code.