Can a nurse practitioner prescribe controlled substances?

Sometimes—and this is where state law diverges the most. Controlled substance authority (Schedule II–V) is governed by a two-layer system: (1) State authority determines whether the NP is permitted to prescribe specific schedules, and whether a collaborative agreement, supervision, extra training, or experience hours are required. (2) Federal authority (DEA registration) determines whether the NP can legally prescribe controlled substances at all under federal law.

Can a nurse practitioner prescribe narcotics?

'Narcotics' usually refers to opioid analgesics, many of which are Schedule II. NPs can prescribe opioids in many states, but the controlling variables include: Does the patient's state authorize Schedule II prescribing for NPs? Is oversight required? Are there quantity/day-supply caps? Are there setting-based restrictions? Are PDMP checks and EPCS mandatory?

What medications can nurse practitioners not prescribe?

There is no single national list, because restrictions are usually schedule-, setting-, and relationship-based. Common 'cannot prescribe' categories include: Schedule II controlled substances in prohibiting states, specific Schedule II use-cases like weight-loss or chronic pain, context-limited prescribing (inpatient/hospice only), quantities exceeding state limits, and telemedicine-controlled substance prescribing when federal pathway is not satisfied.

What are nurse practitioner DEA license requirements?

DEA requirements are the federal gatekeeper for controlled substances. The checklist includes: (1) State prescriptive authority, (2) DEA registration for Schedule II–V, (3) State controlled substance registration when applicable, (4) PDMP compliance, and (5) EPCS (electronic prescribing for controlled substances). State authority determines eligibility; DEA registration operationalizes controlled substance prescribing federally.

How does nurse practitioner prescriptive authority by state affect telemedicine?

It's decisive. Telemedicine prescribing is the intersection of: the NP's authority in the patient's state (Full vs Reduced vs Restricted; Schedule II–V permissions; supervision/collaboration rules), and federal overlays (Ryan Haight baseline, plus the evolving DEA telemedicine framework). In a multi-state telemedicine model, compliance requires state-by-state authority + DEA registration requirements + documentation + PDMP + modality controls.

Can nurse practitioners prescribe Adderall (Stimulants)?

Yes, but with strict caveats. Adderall is a Schedule II controlled substance. In FPA states, NPs can prescribe independently. In restricted states, a collaborative agreement or supply limits (e.g., 30 days) often apply. For telemedicine, the Ryan Haight Act generally requires an in-person exam first, unless you hold a DEA Telemedicine Special Registration.

Can nurse practitioners prescribe Xanax (Benzodiazepines)?

Yes. Benzodiazepines are Schedule IV drugs. While most states allow this, some health systems or specific state protocols (like in Texas or Florida) may require additional monitoring or physician oversight due to the high risk of dependency.

Can nurse practitioners prescribe Ozempic or Wegovy (Weight Loss)?

Yes. Nurse practitioners prescribe weight loss medications (GLP-1 agonists) frequently. Since these are non-controlled legend drugs, restrictions are far looser than for opioids or stimulants. However, scope-of-practice laws still apply regarding diagnosis and management.

Nurse Practitioner Prescriptive Authority by State (2026 Guide): Controlled Substance Laws

Disclaimer: This article is for educational purposes only and does not constitute legal or clinical advice. Always verify your state's nurse practitioner prescribing guidelines.

The Current Landscape of Prescriptive Authority

In my analysis of legislative trends, the legal architecture governing nurse practitioner prescribing authority is undergoing a tectonic shift.

In practical terms, nurse practitioners can prescribe medication nationwide, but controlled substance prescribing depends on each state’s nurse practitioner prescriptive authority (full, reduced, or restricted).

We are moving away from a physician-centric monopoly toward a decentralized model where Mid-Level Practitioners (MLPs)—specifically Nurse Practitioners (NPs)—hold significant autonomy. Many patients and policy-makers frequently ask, "Can nurse practitioners prescribe medication independently?" The answer depends entirely on geography.

As an expert in healthcare policy, I have compiled specific statutory variations to help you navigate this complex compliance framework and understand nurse practitioner prescribing laws by state.

Nurse practitioner prescriptive authority by state defines whether an NP may prescribe medications independently or under physician oversight, and whether Schedule II–V controlled substances are permitted. Authority is classified as Full, Reduced, or Restricted, with additional federal DEA requirements governing controlled substance prescribing.

Do nurse practitioners write prescriptions?

Yes. Do nurse practitioners write prescriptions in every state? In practice, they can prescribe medications nationwide, but the scope—especially for Schedule II–V controlled substances—varies based on state rules for collaboration, supervision, and any additional state controlled-substance requirements.

For a comparison of how prescribing autonomy differs between professions, see our guide to Physician Assistant Prescriptive Authority by State.

Which states allow Nurse Practitioners full prescribing authority?

28 states, the District of Columbia, and two territories grant NPs Full Practice Authority (FPA).

This authorizes NPs to evaluate patients, diagnose, and prescribe medications (including Schedule II-V controlled substances) under the exclusive licensure of the state board of nursing, without physician oversight.

In FPA states, the NP is the captain of the ship, holding independent prescriptive authority. Licensure is not contingent on what the AANP describes as "unnecessary contracts or relationships with a physician" [1]. This model is currently the standard in the entire Pacific Northwest and much of the Southwest [2].

However, "Full Practice" often comes with caveats. For example, California is in a multi-year transition. NPs are classified as "103 NPs" (working in facilities) or "104 NPs" (independent) [3]. Full independence requires 4,600 hours or three years of clinical experience before the "leash" is fully cut [3]. Similarly, Virginia requires five years of clinical experience before an NP can practice without a patient care team physician [3].

Conversely, in Restricted Practice states like Georgia and South Carolina, NPs are severely limited. In Georgia, NPs are prohibited from prescribing Schedule II drugs entirely [3]. In South Carolina, NPs are restricted from Schedule II prescribing except for very limited supplies (5-day limit for narcotics), despite pending legislation to expand this scope [3].

Federal Shift: The DEA Telemedicine Special Registration

Proposed DEA rules create a "Special Registration" for telemedicine prescribing.

This allows practitioners to prescribe Schedule II-V drugs without an in-person visit if they hold this registration, conduct a nationwide PDMP check, and verify patient identity via audio-video technology.

State law is only half the battle; federal law is the other. Under the Ryan Haight Act, an in-person medical evaluation is required before prescribing controlled substances [3]. The COVID-19 Public Health Emergency (PHE) waived this, but those waivers expire at the end of 2025 [3].

To solve this, the DEA released a proposed rule in January 2025 establishing a Telemedicine Special Registration [3].

Nurse practitioner DEA license requirements (and the DEA application)

State authority governs whether you may prescribe, but DEA registration governs what controlled substances you may prescribe federally. In general, NPs should confirm: (1) state prescriptive authority, (2) any state controlled-substance registration, and (3) the appropriate DEA registration before prescribing Schedule II–V medications. (Educational overview only—verify your state’s rules.)

Can a nurse practitioner prescribe Adderall via telemedicine?

Can a nurse practitioner prescribe Adderall (Schedule II) via telemedicine? Potentially—but it depends on (1) whether the patient’s state grants Schedule II authority to NPs, and (2) whether federal rules allow the telemedicine pathway you’re using (e.g., the proposed DEA Special Registration framework and related identity/PDMP requirements).

The Workflow: If you are an NP in a "Full Practice" state, you still need this federal Special Registration to prescribe Adderall (Schedule II) or Testosterone (Schedule III) via Zoom without seeing the patient in person first [3].
The Catch: You must hold a DEA registration in every single state where your patients are located [3].
The Buprenorphine Exception: A separate final rule allows for the induction of Buprenorphine (for Opioid Use Disorder) via audio-only telemedicine without the Special Registration, expanding access significantly [3].

Nurse Practitioners Prescribing Authority Table (2026)

The following table synthesizes data regarding nurse practitioner prescribing laws by state, specifically focusing on their ability to prescribe controlled substances (CS).

FPA: Full Practice Authority (Independent)
Reduced: Collaborative agreement required
Restricted: Supervision required
Sch II: Schedule II Controlled Substances

State	NP Authority	Key Prescribing Notes
AL	Reduced	NP: Sch III-V only. Sch II prohibited [3].
AK	Full	NP: Independent [3].
AZ	Full	NP: Independent [3].
AR	Reduced	NP: Collaborative agreement required [3].
CA	Restricted*	*NP: Transitioning to FPA (103/104 status). Sch II requires course [3].
CO	Full	NP: Independent [3].
CT	Full	NP: Independent after 3 years [3].
DE	Full	NP: Independent upon licensure [3].
FL	Restricted	Florida nurse practitioner prescribing laws limit Sch II to 7-day supply [3].
GA	Restricted	Restriction: NP prohibited from prescribing Sch II [3].
HI	Full	NP: Independent [3].
ID	Full	NP: Independent [3].
IL	Reduced	NP: Full practice eligible after 4,000 clinical hours [3].
IN	Reduced	NP: Sch II-V requires agreement. No weight loss Sch IIs [3].
IA	Full	NP: Independent [3].
KS	Full	NP: Independent [3].
KY	Reduced	NP: Sch II-V requires CAPA-CS agreement [3].
LA	Reduced	NP: Sch II prohibited for obesity/chronic pain [3].
ME	Full	NP: Independent after 24 months [3].
MD	Full	NP: Independent after 18-month mentorship [3].
MA	Full	NP: Independent after 2 years [3].
MI	Restricted	NP: Requires delegation [3].
MN	Full	NP: Independent after 2,080 hours [3].
MS	Reduced	NP: Sch II requires QA program/chart review [3].
MO	Restricted	NP: Restricted practice environment; delegation/supervision required [3].
MT	Full	NP: Independent [3].
NE	Full	NP: Independent after 2,000 hours [3].
NV	Full	NP: Sch II requires 2,000 hours/protocol [3].
NH	Full	NP: Independent [3].
NJ	Reduced	NP: Joint protocol required [3].
NM	Full	NP: Independent [3].
NY	Full	NP: Independent after 3,600 hours [3].
NC	Restricted	NP: Sch II/III limited to 30-day supply [3].
ND	Full	Standout: NP practices independently [3].
OH	Reduced	NP: Sch II restrictions (e.g., terminal illness, MD initiation) [3].
OK	Restricted	Restriction: NP excluded from independent Sch II [3].
OR	Full	NP: Independent [3].
PA	Reduced	NP: Sch II limited to 72hr (initial) or 30-day (ongoing) [3].
RI	Full	NP: Independent [3].
SC	Restricted	Restriction: NP Sch II limited (5-day narcotic/30-day non) [3], [4].
SD	Full	NP: Independent after 1,040 hours [3].
TN	Restricted	NP: Sch II/III limited to 30-day supply [3].
TX	Restricted	Texas nurse practitioner prescribing laws: Sch II limited to hospital/hospice settings [3].
UT	Full	NP: Independent [3].
VT	Full	NP: Independent after 24 months [3].
VA	Restricted	NP: Becomes independent after 5 years of clinical experience (transitions to autonomous practice after the experience requirement) [3].
WA	Full	NP: Independent [3].
WV	Reduced	NP: Sch II limited to 3-day supply [3].
WI	Reduced	NP: Sch II-V authorized [3].
WY	Full	NP: Independent [3].

NP Prescribing Authority by State Map (2026)

NP Prescribing Authority Map

Figure: State-by-state breakdown of Nurse Practitioner prescribing authority, showing Full Practice Authority (FPA), Reduced, and Restricted practice environments.

Why Manual Checks Fail: The Case for Automated Compliance

The trajectory is clear: autonomy is expanding.

Whether through the adoption of the APRN Compact in states like Utah and Delaware, the tether between NPs and physicians is loosening [7]. However, this freedom comes with increased administrative liability—specifically regarding PDMP checks and the new DEA Special Registration for telemedicine.

If you are a practitioner operating across state lines, you cannot rely on a single license.

You must cross-reference your "home" state's authority with the "patient's" state laws and federal DEA overlays [7].

Don't navigate this alone.

Rx Agent functions as an automated compliance layer for NPs operating across state lines—instantly validating state prescriptive authority, DEA eligibility, PDMP obligations, and telemedicine pathways in real time.

References

1. https://www.aanp.org/advocacy/advocacy-resource/policy-briefs/issues-full-practice-brief

2. https://nurse.org/education/np-full-practice-authority/

3. https://www.tebra.com/theintake/checklists-and-guides/legal-and-compliance/nurse-practitioner-laws-by-state

4. https://www.scstatehouse.gov/billsearch.php?billnumbers=3580

5. https://nacns.org/wp-content/uploads/2020/08/PractPrescAuthority7.31.2020.pdf

6. https://www.dlapiper.com/insights/publications/2025/01/dea-and-hhs-publish-rules-for-telemedicine-prescriptions

7. https://www.govinfo.gov/content/pkg/FR-2025-01-17/pdf/2025-01099.pdf