Q. What is the maximum quantity of a CII that may be prescribed for acute pain by an APRN? Please note per KRS 314.011(8),the only Schedule II controlled substance used to treat pain that an APRN may prescribe for greater than a 3 day supply is any hydrocodone combination product. For all other Schedule II controlled substances used to treat pain, KRS 314.011(8) limits the quantity to a 3 day supply with no exceptions.
A. KRS 218A:205, limits the prescribing of a Schedule II controlled substance used to treat acute pain by all practitioners who are allowed to prescribe Schedule II controlled substances to a 3 day supply. KRS 314.011(8) limits all Schedule II controlled substances with the exception of hydrocodone combination products (and ADD/ADHD medication in specific circumstances) to a 3 day supply. The exceptions for an APRN to prescribe greater than a 3 day supply of HYDROCODONE COMBINATION PRODUCTS ONLY are:
- In the professional judgment of the APRN, more than a 3 day supply is needed. The need must be documented . For the purposes of pharmacy dispensing, the medical necessity for the hydrocodone combination product as documented by the APRN in the patient’s medical record and the prescription for more than a 3 day supply for the hydrocodone combination product are presumed to be valid.
- Treating chronic pain.
- Treating cancer pain.
- Treating a patient at end of life or in Hospice.
- Treatment of pain after major surgery or significant trauma as defined by the licensing Board and the Office of Drug Control Policy.
- Administered directly to the patient in an inpatient setting. Administered directly to the patient in an inpatient setting.
- Scenarios authorized by the licensing board.
- Please note, APRNs must still follow prescribing limits set forth in KRS 314.011.
Q. Can a Suboxone prescription (CIII) issued by a nurse practitioner contain refills?
A. The Kentucky Board of Nursing has provided the following clarification on Suboxone prescriptions: "Under the language of the statute (KRS 314.011 (8)), a single prescription cannot be refillied, and the total number of doses should not exceed the statutory 30-day supply limit." If a nurse practitioner has any further questions, please direct them to the Kentucky Board of Nursing.
Q. What controlled substances may an APRN prescribe?
A. CII – 3 day supply, KRS 314.011(8) with exceptions:
Psychostimulants if APRN is certified in psychiatric-mental health 30 days, KRS 314.011(8) and hydrocodone combination products 30 days. KRS 218A.020(3)
CIII – 30 day supply no refills. KRS 314.011(8)
CIV – V – 6 month supply, KRS 314.011(8)
Please note that 201 KAR 20:059, limiting carisoprodol, alprazolam, diazepam, clonazepam, and lorazepam to 30 days with no refills has been repealed and these limitations no longer exist. Updated February 24, 2021
Q. What controlled substances may a PA prescribe?
A. CII - PA's may not prescribe CII's.
CIII- 30 day supply no refills, KRS 311.858(5)(c)
CIV-V - 6 month supply, KRS 311.858(5)(d) with exceptions: Benzodiazepines C IV and Carisoprodol (Soma) C IV. All limited to 30 day supply with no refills. KRS 311.858(5)(e)
Q. What controlled substances may an out of state APRN or PA prescribe?
A. APRN and PA controlled substance prescribing varies from state to state. Kentucky pharmacists should only dispense a controlled substance prescription for an out of state APRN and PA up to the authority they would have if it were a Kentucky APRN or PA.
Q. What is the maximum quantity of a CII that may be prescribed by various practitioners?
MD/DO: Other than the 3 day limit for acute pain and the exemptions listed above, there is no maximum quantity in state or federal law
DMD/DDS: Other than the 3 day limit for acute pain and the exemptions listed above, there is no maximum quantity in state or federal law; however, it should be only of a sufficient amount to treat the patient. KRS 313.035(6)
DVM: Other than the 3 day limit for acute pain and the exemptions listed above, there is no maximum quantity in state or federal law. 201 KAR 16:110
DPM: Other than the 3 day limit for acute pain and the exemptions listed above, there is no maximum quantity in state or federal law. 201 KAR 25:090
APRN: Other than the 3 day limit for acute pain and the exemptions listed above for hydrocodone combination products ONLY, APRNs are limited to a 3 day supply with exceptions for ADD/ADHD drug if certified in mental health for up to 30 days, KRS 314.011(8) and hydrocodone combination products for up to 30 days. KRS 218A.020(3)
OD: limited to a 72 hour supply of hydrocodone combination products, KRS 218A.020(3) but may not prescribe any other CII. KRS 320.240(13)
PA's may not prescribe CII's.