This article will provide you with an overview of two categories of medications–non-controlled and controlled–and explain the different prescribing rules in certain states and how they impact patients at Rula.
Overview: What are non-controlled and controlled medications?
Rula Psychiatrists and Psychiatric mental health nurse practitioners are specialized mental health care providers who use medication management in addition to therapy services to treat a variety of mental health conditions. Medication is classified into two broad categories: non-controlled medications and controlled medications.
Non-Controlled Medications
Definition: Medications not deemed to have significant abuse or dependence potential.
Examples in mental health:
- Antidepressants (e.g., Prozac, Zoloft)
- Antipsychotics (e.g., Risperdal, Abilify)
- Non-stimulant ADHD medications (e.g., Strattera)
Key Points:
- These medications are easier to prescribe and refill.
- Primarily focus on treating symptoms without significant risk of misuse.
Controlled Medications
Definition: Medications regulated by the government (e.g., DEA in the U.S.) due to a higher potential for abuse and dependence.
Examples in mental health:
- Benzodiazepines (e.g., Xanax, Ativan, Klonopin) for anxiety
- Stimulants (e.g., Adderall, Ritalin) for ADHD
- Certain sleep aids (e.g., Ambien)
Key Points:
- These medications require stricter prescribing rules (e.g., limited refills, regular monitoring).
- Misuse can lead to addiction or harm.
Controlled medications require prescriptions from a healthcare provider, as do many non-controlled medications. Non-controlled medications can be prescribed by any provider that contracts with Rula, at their discretion. However, certain controlled medications have explicit restrictions on how they can be filled and refilled. These medications are categorized into schedules based on their medical use, potential for abuse, and safety or dependence risk (Schedule I through Schedule V). The rules for prescribing them can differ by state.
Source: Controlled Substances - StatPearls - NCBI Bookshelf
Prescribing rules vary by state
States in which providers that contract with Rula are unable to prescribe controlled medications
Six states prohibit Psychiatric Nurse Practitioners (NPs) and Psychiatrists (MDs) from prescribing controlled medications (Schedules II-V) without an in-person relationship with their patients. Due to this constraint, Rula alerts patients during the sign-up process that providers who contract with Rula cannot prescribe controlled medications in these states.
The states in which this is the case are:
- Hawaii
- Arkansas
- Oklahoma
- New Hampshire
- Alabama
- New Jersey
States in which Psychiatric Nurse Practitioners that contract with Rula are unable to prescribe Schedule II controlled medications
Seven states prohibit Psychiatric Nurse Practitioners from prescribing Schedule II medications, so in these states, Rula cannot currently serve patients requiring stimulants (e.g., patients with ADHD).
Due to this constraint, Rula alerts patients during the sign-up process that Psychiatric Nurse Practitioners who contract with Rula cannot prescribe Schedule II controlled medications in these states. However, Rula contracts with Psychiatrists (MDs) in certain states below, and they are allowed to prescribe Schedule II controlled medications in these states.
The states in which this is the case are:
- Georgia
- Kentucky
- Missouri
- Ohio
- Texas
- West Virginia
- Wisconsin
Note: Prescriptions are entirely up to the provider’s discretion based on their individual clinical assessment of each patient’s situation, and Rula cannot guarantee that certain medications will be prescribed by contracted providers.