In our response, we discuss federal and state laws, ethical considerations, and licensing requirements. Federal law does not prohibit physicians in the United States from self-prescribing drugs. However, state laws for doctors vary widely, and some may prohibit doctors from prescribing, dispensing, or administering certain medications to themselves or their family members. Depending on their jurisdiction, physicians may also face disciplinary action for writing prescriptions outside of their medical practice, which may include self-prescriptions. For example, NPs have the normative authority to prescribe controlled substances in all fifty states. However, NPs cannot prescribe Schedule II drugs in Georgia, Oklahoma, South Carolina, and West Virginia.  In addition, the laws of the states of Arkansas and Missouri limit NPs to prescribe only Schedule II combinations of hydrocodone. In particular, surveys have shown that many NPs have used strategies to prescribe controlled substances that were not strictly legal. These strategies included using pre-signed prescription pads, signing the prescription by a physician without consultation, and prescribing planned medications without the physician`s involvement.  Medical Assistant (MA) – certified, MA certified and MA hemodialysis technician (chapter RCW 18.360, WAC 246-827) – administration of prescribed medications in practice (see RCW 18.360.050) and under the supervision of a naturopath according to RCW 18.360.010(3). The hemodialysis technician can administer oxygen and medications needed for hemodialysis (see WAC 246-827-0500 and WAC 246-827-0520).
Individuals enrolled in MA may administer eye drops, topical ointments and vaccines, including combination or multi-dose vaccines. See WAC 246-827-0240 for MA certification. A physician who has established a good faith doctor-patient relationship with a patient in accordance with the provisions of this paragraph may prescribe controlled substances listed in Schedules II to VI to that patient. The first class of Physician Assistants (PAs) was founded in 1965 and trained in a two-year accelerated program.  This new category of health professionals was created as an innovative solution to the physician shortage. All PAs must have some degree of medical supervision; However, the relationship varies depending on state law. Some states also have restrictions on the drugs PAs are allowed to prescribe by law. The first graduate programs for nurses (NPs) were created in the 1960s to improve public access to pediatric care.  These advanced practice providers have been similarly trained to respond to a growing shortage of physicians.
Unlike their PA counterparts, NPs in some states have broader normative privileges and do not require medical oversight. However, some states also prohibit NPs from prescribing controlled substances. A risk manager recently sought advice about providers who self-prescribe medications. Registered General Practice Nurse (RPN) (Chapter 18.79 RCW, WAC 246-840) – Administer prescribed medications in the practice area, under the general direction of an ARNP, MD, DO, DPM, DDS, PA or ND and under the direction or supervision of a nurse. This paragraph does not apply to: (1) a prescribing physician who is on call under an agreement entered into with another prescribing physician or the professional order or employer of his prescribing physician; (2) a prescribing physician who consults another prescribing physician concerning the care of a patient; or (3) prescribing physician prescriptions for ambulatory or inpatient patients. Some physician groups expressed concern about the increasing prescribing power of advanced practice providers. The current literature is mixed with differences in provider care compared to physicians and advanced practice providers. Some studies have found a higher average of opioid prescriptions written by NPs and PAs compared to physicians.   However, other studies have shown that the general prescribing habits of advanced practice providers are comparable to those of physicians.
 One study found that PAs are slightly more likely to prescribe controlled substances to patients than physicians or NPs.  In addition, researcher bias may contribute to the often contradictory conclusions of the literature. Overall, remember that every prescription you write must be supported by documents, even if the medication is prescribed outside of your practice. The prescription of controlled substances outside of a bona fide provider-patient relationship is prohibited by federal law, so prescribing these drugs to personal contact is prohibited in most circumstances. After all, by prescribing medication to anyone, whether it`s a friend, family member or stranger on the street, you are establishing a legally binding provider and patient relationship with that person and you can be held accountable for the consequences of that interaction. Registered midwife (RCW 18.50.115, WAC 246-834-250) – purchase and administration of certain medications. May also administer medications prescribed by a doctor. Physiotherapists (PT) (Chapter 18.74 RCW) – May purchase, store and administer certain medications as required by law, and may administer those other medications or medications prescribed by a physician licensed to practice physiotherapy. A physician who has established a bona fide physician-patient relationship with a patient in accordance with the provisions of this subsection may prescribe controlled substances in Schedules II to VI by telemedicine to that patient if the prescription meets the federal requirements for the practice of telemedicine and, in the case of a prescribed substance in Schedules II to V, The prescribing physician practises in a physical location in the Commonwealth, or is able to refer patients appropriately to a Commonwealth licensed physician to ensure a personal examination of the patient if required by the standard of care. Emergency Physician (EMT) (RCW 18.73.081) – Administer prescribed medications in practice in accordance with oral or written instructions from the MD or DO, who are also certified as County Medical Program Director (MPD) or MPD delegate.