|(a) APRNs with full licensure and a valid prescription
authorization number are eligible to obtain authority to order and
prescribe certain categories of controlled substances. The APRN must
comply with all federal and state laws and regulations relating to
the ordering and prescribing of controlled substances in Texas, including
but not limited to, requirements set forth by the United States Drug
(b) Orders and prescriptions for controlled substances
in Schedules III through V may be authorized, provided the following
criteria are met:
(1) Prescriptions for a controlled substance in Schedules
III through V, including a refill of the prescription, shall not exceed
a 90 day supply. This requirement includes a prescription, either
in the form of a new prescription or in the form of a refill, for
the same controlled substance that a patient has been previously issued
within the time period described by this subsection.
(2) Beyond the initial 90 days, the refill of a prescription
for a controlled substance in Schedules III through V shall not be
authorized prior to consultation with the delegating physician and
notation of the consultation in the patient's chart.
(3) A prescription of a controlled substance in Schedules
III through V shall not be authorized for a child less than two years
of age prior to consultation with the delegating physician and notation
of the consultation in the patient's chart.
(c) Orders and prescriptions for controlled substances
in Schedule II may be authorized only:
(1) in a hospital facility-based practice, in accordance
with policies approved by the hospital's medical staff or a committee
of the hospital's medical staff as provided by the hospital's bylaws
to ensure patient safety and as part of care provided to a patient
(A) has been admitted to the hospital for an intended
length of stay of 24 hours or greater; or
(B) is receiving services in the emergency department
of the hospital; or
(2) as part of the plan of care for the treatment of
a person who has executed a written certification of a terminal illness,
has elected to receive hospice care, and is receiving hospice treatment
from a qualified hospice provider.
(d) Prescription Monitoring Program (PMP).
(1) APRNs should access and review the prescription
monitoring program (PMP) authorized by Chapter 481, Health and Safety
Code, prior to prescribing any controlled substance for patients being
treated for pain.
(2) APRNs must access and review the PMP before prescribing
opioids, benzodiazepines, barbiturates, or carisoprodol unless:
(A) the patient has been diagnosed with cancer or the
patient is receiving hospice care; and
(B) the APRN clearly notes on the prescription or in
the electronic prescription record that the patient was diagnosed
with cancer or is receiving hospice care, as applicable.
(3) An APRN will not be subject to disciplinary action
if the APRN:
(A) makes a good faith attempt to access and review
the PMP prior to prescribing opioids, benzodiazepines, barbiturates,
or carisoprodol, but is unable to access the information because of
circumstances outside the control of the APRN; and
(B) clearly notes on the patient's prescription or
in the patient's electronic prescription record the APRN's attempt
to access and review the PMP and the circumstances that prevented
the APRN from being able to do so.
(4) Documentation that the review of the PMP occurred
and rationale for prescribing a controlled substance must be included
in the patient's medical record.
(5) This section takes effect September 1, 2019.