Controlled Substances
This provider type can prescribe controlled substances in most states if they hold DEA registration.
nurse practitioners
You are not required to prescribe medications that you believe are unsafe, inappropriate, or outside standard practice
True
You can decline to see a patient simply because they make you feel uncomfortable
True
When a patient reports outside treatment you disagree with, this is the first step
Assess safety and gather full information
Robitussin AC
Schedule V
Drugs with no currently accepted medical use and a high potential for abuse
Schedule I
This is the first step when inheriting a patient on long-term controlled medications
Reviewing records and verifying diagnosis/indication
“I will end up in the ER if you don’t refill this. Do you want that on your conscience? Every new provider thinks they know better than the one before. This is why people hate doctors.”
Emotional manipulation + catastrophizing
This approach allows you to educate patients while maintaining trust and autonomy
Shared decision-making and counseling
Adderall
Schedule II
Hydrocodone/acetaminophen (e.g., Norco, Vicodin) falls into this controlled substance schedule.
Schedule II
When taking over care, this documentation protects the provider and clarifies expectations moving forward
A new controlled substance agreement and care plan
“My last doctor gave me 120 oxy a month. If you’re not going to refill it today, just tell me now so I don’t waste my time. I’ve been on this for YEARS. Are you calling my old doctor incompetent?”
demands continuation, appeals to authority, time pressure
Can you walk me through what you’re taking and what you were told it’s for?
Start with curiosity
Ativan
Schedule IV
Drugs under this schedule do not allow refills, must be filled within 90 days, and can have three future scripts written at one time
Schedule II
You must immediately stop all controlled meds you do not agree with or think were prescribed unnecessarily
FALSE
“That VPMS thing is wrong. I don’t even go to those pharmacies. You’re just looking for an excuse not to prescribe. This is discrimination—people like me always get treated like drug seekers.”
Data denial + accusation of bias
These medications made at pharmacies aren't FDA approved and are not checked for consistency and purity
compounded medications
Best practice recommends reassessing risks, benefits, and function at least this often for patients on chronic controlled medications.
Every 3 months
This monitoring database should be checked before prescribing controlled substances to review prior fills and prescribers
Vermont Prescription Monitoring System (VPMS)
This document sets clear expectations for how you or your office manage controlled substances
A standardized policy: potential elements to include
-one prescriber one pharmacy
-regular follow ups (1-3 months)
-clear policy on drug screens
-no early refills/no replacement for lost meds
-clear criteria for continuation vs taper
“I looked you up. You’re new, right? Not even fully independent yet? Maybe you should talk to someone with more experience before you screw this up.”
Undermining credibility + intimidation
I won't manage what I didn't start
Boundary and expectation setting
“I’m not comfortable managing side effects, refills, or dose adjustments for medications I didn’t prescribe and wouldn’t prescribe myself.”
Testosterone
Schedule III