Coalition for Nurses in Advanced Practice
 

Five Steps to Obtaining DPS and DEA Numbers            

Just like a physician, an APRN who writes a prescription for a controlled substance in Texas must have a state controlled substances registration (CSR) issued by the Texas Department of Public Safety (DPS) and a federal Drug Enforcement Agency (DEA) number. There are five steps each APRN must complete before signing a prescription for a controlled substance.

STEP 1 – APRNs must be licensed to practice as an APRN from the Texas Board of Nursing (BON). Those with Interim Approval are not eligible to prescribe.

STEP 2 -- The delegating physician must agree to delegate authority to prescribe controlled substances and affirm the agreement in the prescriptive authority agreement (PAA) or facility-based protocol.

The PAA or protocol must reflect that the APRN may prescribe controlled substances, the schedules of controlled substances the APRN may prescribe, and any restrictions on that authority. By law, the APRN has certain restrictions on prescribing controlled substances, and for clarity, these restrictions should be included in the PAA or facility-based protocols. Most APRNs are limited to prescribing:

  1. Schedules III-V;
  2. a maximum 90-day supply with no refill;
  3. additional prescriptions for the individual, only with prior consultation with the physician; and
  4. for persons younger than 2 years of age only after prior consultation with the physician.

In addition, any consultation with the physician must be noted in the patient’s chart. The physician can place additional limitations on the APRN’s authority to prescribe controlled substances, just as he/she can in delegating authority to prescribe any other drugs. If the physician elects to impose any additional restrictions, include those limitations in the PAA or facility-based protocol.

Facility-based physicians may also delegate ordering and prescribing Schedule II Controlled Substances to APRNs in hospices and certain hospital facility-based practices. In hospitals, physicians may only delegate ordering and prescribing Schedule II drugs to APRNs and PAs treating ER patients and in-patients with a length of stay of at least 24 hours. If an APRN signs a Schedule II drug prescription for a patient being discharged, the patient must fill the prescription at the hospital’s outpatient pharmacy. (This does not limit physicians from delegating authority for APRNs and PAs to write for Schedule II drugs in hospitals under a physician’s standing medical order.)

STEP 3 – The APRN must register as a person who may prescribe controlled substances with the Texas Department of Public Safety DPS. This cannot be accomplished online, but the APRN can download the CSR application form for APRNs and PAs. There is a $25 fee. All CSRs will expire on August 31, 2016. Starting September 1, 2016, the State of Texas will no longer require a state CSR. Refer to DPS Controlled Substances Registration webpage for additional information.

In addition to the instructions on the form, also follow these instructions so DPS will process the application as quickly as possible.

  • Provide the name and business address of the practice site. (Addresses must be a physical location, not simply a PO Box.) Even if you have prescriptive privileges in more than one site, most APRNs will only have to apply for a permit for one site. Only if the APRN is the person responsible for storing and maintaining records on controlled substances at multiple sites will the APRN have to register for more than one permit.  If the physician/medical director is responsible for the controlled substances, then the APRN only registers for the primary practice location. If of the APRN's registration information (i.e., name, site, delegating physician or schedules the physician delegates) changes in the future, the APRN must modify the registration and the new delegating physician will need to sign that form (see below).
  • APRNs must specify the APRN title they have been authorized to use by the Board of Nursing (e.g. FNP, GNP, PNP, etc).  Avoid academic and certification credentials such as MSN, APRN, BC or C, etc. Using these credentials on the application to identify the APRN’s role and specialty could cause the application to be returned.
     
  • Enter your RN license number and write your name on the application IDENTICALLY to your name as it appears on your RN license.  If there are name changes, the name must be changed with the BON prior to submitting the application to DPS.
     
  • The name, contact information, and signature of the delegating physician are required.  If additional physicians currently delegate prescriptive authority, they must also sign the application form. 

Once submitted, the DPS issues the permit within 60 days. However, many APRNs receive the CSR number much more quickly.

STEP 4 - Obtain a DEA number. The application form for the federal Drug Enforcement Administration (DEA) license number is submitted online. This On-Line Application System allows one to complete and submit the form online and will reduce potential errors and processing time. For the online submission form, go the DEA Diversion Website.  The application fee is $731. That fee covers a period of approximately 3 years. (The initial DEA registration period may vary from a minimum of 28 months to a maximum of 39 months.)

The DEA registration process is very easy, but it is important to get all the details right. You must include your DPS registration number until September 1, 2016. Any inconsistent answer can cause delay processing your application. In completing the application form, first read the instructions. The following information will also help in completing the application correctly. 

In the space that asks for business activity, select “Mid-Level Practitioner” and the professional degree, is Nurse Practitioner. Put “NP” no matter what type of APRN you are.  In this instance, NP represents a broad category and it is the most appropriate option available even if you are a CNS, CRNA or CNM.

Applicants are asked to mark the drug schedules. APRNs in Texas check four boxes, “Schedule III Narcotic,” “Schedule III Non Narcotic,” “Schedule IV” and “Schedule V.” If you are a hospice or facility-based APRN and the physician delegated Schedule II drugs, that are both narcotic and non-narcotic (IIN), then also check II(2) and IIN(2N). Do not check the box labeled “order forms.” 

Enter your Texas RN license number. Under “State Controlled Substance License,” mark “yes” if you are applying prior to September 1, 2016, and enter the DPS registration number the box labeled “State Controlled Substance No.” Remember, if you fail to enter your state CSR, and one is required, then DEA will not process your application and will not refund your application fee.

STEP 5 – Writing the prescription for a controlled substance. Prescriptions for Controlled Substances, Schedules III – V are written on a standard prescription form or may be faxed, called to the pharmacy, or sent electronically. APRNs do not need to change their prescription pads just because they obtain a DEA number. While some may wish to print their DEA number, in addition to their BON prescriptive authority number, on the prescription form, it is not required to do so. Only prescription for controlled substances require a DEA number. Also include the DEA number for the delegating physician. The APRN may print these numbers on the prescription form by hand.

To read the pertinent BON rule that include requirements for prescriptions, read BON Rule 222.4. The Texas State  Board of Pharmacy requires the following information to be included on the prescription form.

  • APRN’s name and professional credentials (i.e. RN, FNP)
  • APRN's BON prescriptive authority number
  • APRN's practice address and phone number where the prescription was issued
  • Delegating physician's name and professional credentials
  • Delegating physician's business address and phone number (if different than APRN's)
  • APRN's and delegating physician's  and APRN's DEA number if prescription is for a CS.

 Prescriptions for Schedule II drugs must be written on an official prescription form or communicated electronically. APRNs may obtain official prescription forms from TxDPS.

Please remember that promoting good working relationships with pharmacists in your area is always time well spent. If you will be prescribing controlled substances, it is a good idea to write a letter to all the local pharmacies explaining that physicians have the option of delegating prescriptive authority for Controlled Substances, Schedules III – V (and in some cases Schedule II), and that your collaborating physician has delegated that authority. You can refer the pharmacists to the TSBP website or this Quick reference guide to verify the pharmacist may fill prescriptions signed by APRNs. The pharmacist may also call the TSBP for information on filling prescriptions signed by an APRN.

If you need to review the medications that are included in the various schedules of controlled substances, go to the DEA Diversion Website  or to the Texas Department of State Health Services.

Renewal of  DEA Number

and Maintaining Current Information
It is absolutely essential that APRNs who have DEA numbers, keep their contact information current . DEA mails renewal reminders; but failure to receive that notice is not an excuse for letting your DEA registration lapse. If an APRN writes prescriptions for controlled substances after either the DPS permit or DEA registration lapses, then the APRN is committing a criminal act. Prescribing these medications without proper permits from TX DPS and DEA can result in a criminal conviction.  The convictions range from third degree felony to a state jail felony (up to 25 years).  They can also be accompanied by a fine of up to $100, 000.   In addition, the APRN would also be in violation of the Nursing Practice Act because the APRN is not conforming to all state and federal laws.

            DEA Change of Information. DEA also requires you inform them of a change in your status. This includes changes in name, address, or the schedules you may prescribe. Use the online registration update form to keep your information current.

            DEA Registration Renewal. Renewal reminders are mailed automatically to the registered location 60 days prior to the expiration date. However, APRNs may renew their DEA registration online.           

Re-Activating a Lapsed DEA Registration. Because the ability to order controlled substances varies from state to state, it is not uncommon for APRNs to have had a DEA number in one state, but let it lapse because the APRN moved to a state that did not have prescriptive authority for controlled substances.

APRNs that are not certain of the status of their DEA registration may check the DEA validation tool to find if the number is only expired, or if the number has been retired. If the number is expired, submit a renewal application online. If your DEA number has been retired, then complete a new DEA application form just like other new applicants. In either case, DEA will send a new DEA certificate.

References and Resources

BON Rule on pain management, 22 TAC §228  http://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=22&pt=11&ch=228&rl=Y 

BON and TMB FAQs on prescriptive authority (includes questions on controlled substances)  http://www.bon.texas.gov/faq_practice_aprn.asp#t9

Department of State Health Services current list of controlled substances,  http://www.dshs.state.tx.us/drugs/controlled-substances.aspx

DEA Controlled Substances Schedules http://www.deadiversion.usdoj.gov/schedules/index.html

Jolene Zych (personal communication, May 13, 2005).

Texas Department of Safety Modification of Registration PA/APN Form must be used to inform DPS of change of address http://www.txdps.state.tx.us/InternetForms/Forms/NAR-117.pdf

Texas DPS Controlled Substances Registration Program,http://www.txdps.state.tx.us/RSD/ControlledSubstances/csforms.htm 

Texas Medical Board Rules on pain management  http://texreg.sos.state.tx.us/public/readtac$ext.ViewTAC?tac_view=4&ti=22&pt=9&ch=170&rl=Y

Texas State Board of Pharmacy: Abuse and Misuse of Prescription Drugs http://www.pharmacy.texas.gov/sb144.asp

Texas State Board of Pharmacy: Quick reference guide on prescription that my be dispensed in Texas https://www.pharmacy.texas.gov/files_pdf/QuickRefGuide.pdf

 

 

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