Prescription Narcotics & Rules For Prescribing Narcotics

Last Updated: October 26, 2020

Authored by Nena Messina, Ph.D.

There are many reasons why a medical professional might prescribe narcotics to a patient. The law defines narcotics as medications that should be prescribed by a doctor only to ease moderate to severe pain, either short and long term.

While most prescription narcotics can be obtained legally provided that there is a strong indication for use, there are also illegal narcotics that can’t be prescribed in the US. With a long prescription narcotics list, heroin and opium are the most commonly abused drugs, contributing to the most number of deaths.

Doctors Who Can Prescribe Narcotics

Ths list of doctors that prescribe narcotics for pain was established by the law. The process of prescribing narcotics is monitored by Federal law and doctors may be held liable if these rules are not followed. What are doctors who can prescribe narcotics? Here are the most common questions about doctors powers regarding these drugs:

  • Can chiropractors prescribe narcotics? The right to prescribe narcotics remains a contentious issue within the chiropractic profession. Depending on the jurisdiction in which the practitioner is licensed to practice, one may have limited independent prescribing rights.
  • Do orthopedic doctors prescribe narcotics? Definitely yes. They are licensed physicians who specialize in the treatment of bones, joints, ligaments, tendons, and muscle disorders. Most of these conditions will also require pain control.
  • Can a doctor of osteopathy prescribe narcotics? Yes. Osteopathic doctors are also licensed physicians. They focus mostly on the joints, muscles, and spines. Their interventions often help treat arthritis, back pain, headaches, postural problems, more.
  • Can a dermatologist prescribe narcotics? As a licensed doctor who specializes in treating skin, hair, nails, and mucous membrane disorders, a dermatologist is also allowed to prescribe the medication in question for pain relief.
  • Can a nurse practitioner write prescriptions for narcotics? Yes, along with medical interns and residents, they can use the hospital’s DEA registration number for writing prescriptions for narcotics.
  • How about medical house staff? Can a physician assistant prescribe narcotics? Yes, they can. A physician assistant is also a skilled person qualified by academic and practical training to offer patient services, which includes writing a prescription, under the supervision and direction of a licensed physician who is responsible for their performance.
  • Can online doctors prescribe narcotics? It’s not possible to prescribe these drugs online without physical examination. While online doctor consultation for prescription narcotics is not practiced in the U.S., there are certain cases wherein doctors can communicate prescriptions either in writing, facsimile to the pharmacist, or orally.
  • Can doctor on demand prescribe narcotics? Yes, doctors on demand can prescribe this type of drugs when necessary for treatment.

doctors who can prescribe narcotics

For other registered practitioners and pain doctors who prescribe narcotics the following rules should be met:

  • Authorized to prescribe controlled substances by the jurisdiction which the practitioner is licensed to practice.
  • Registered with DEA or exempted from registration, which includes Public Health Service, Federal Bureau of Prisons, and Military Practitioners.

While many people abuse pain medications, laws for doctors prescribing narcotics are strict. Doctors are careful of issuing narcotics prescriptions because of the fear of sanctions and considering that many people abuse this type of drug. This is a legitimate worry, not to mention drug seekers, who show up in doctor’s offices and hospitals pretending to have a medical need for these pain medications.

DEA Rules On Prescribing Narcotics

Different narcotics fall under different schedules, and the DEA rules on prescribing narcotics was established for each schedule.

Information Required When Prescribing Schedule II Narcotics

Schedule II drugs require a written order with a signature from a medical specialist. The prescription should also include the date, patient’s name and address, practitioner’s complete name, address, and DEA registration number, drug name, strength, dose, quantity, and directions for use.

If one needs multiple prescriptions for schedule II drugs, a doctor can authorize a patient to buy a supply for 90 days. A doctor can issue separate prescriptions with notes indicating the earliest date of filing, provided that it is allowed by the state laws. A doctor must conclude that providing the patient with several prescriptions will not create an undue risk of abuse.

E-prescribing narcotics, which uses a technology framework that allows doctors and other medical practitioners to write and send prescriptions to a pharmacy electronically instead of using handwritten or faxed notes, is not allowed for the schedule 2 drugs.

E-prescribing narcotics

Prescribing Narcotics Through Facsimile

Prescribers can expedite filling by transmitting a schedule II prescription by facsimile, provided the original order is presented to the pharmacist for review. During emergency cases, a practitioner may call-in a prescription for schedule II drugs by telephone to the pharmacy, and the pharmacist may dispense the quantity needed to treat the patient during the emergency period only. The prescriber should hand a written and signed the order to the pharmacist within 7 days. Also, the pharmacist should notify the DEA if the prescription is not received.

The DEA guidelines for prescribing narcotics have granted 3 exceptions to the above-mentioned facsimile prescription requirements for schedule II drugs:

  • If the drug is needed for direct administration to a patient through IV, IM, parenteral, subcutaneous, or intraspinal infusion, a facsimile prescription is enough. There’s no written order needed for verification, provided that other normal requirements of a legal prescription have been followed.
  • Doctors prescribe this type of drugs through facsimile or ask an agent to transmit the prescription to the pharmacy if they are intended for residents of long term care facilities (LTCF). The facsimile copy serves as the original written order for the pharmacy.
  • Facsimile prescription is also allowed if the drugs are for patients enrolled in a hospice care program approved by Medicare or licensed by the state. The order can also be handled by an agent to the pharmacist. With a note saying “for a hospice patient,” the facsimile prescription serves as the original document.

doctor is writing facsimile prescription

Ways to Prescribe Schedule III-IV Narcotics

For schedule III-V drugs, prescriptions can be communicated either in writing, facsimile to the pharmacist, or orally. They can be refilled immediately if so authorized on the paper or by call-in. However, they can only be refilled up to 5 times within 6 months, whichever comes first, after it was signed. After this, a newly written order is needed.

Necessity Of Prescriptions Regulations for Narcotics

There are many legal requirements and controls in the forms of contracts, narcotics prescription security paper, and record-keeping, to help regulate their use. The DEA has been active in addressing the problems with prescription drug abuse, including semi-synthetic and synthetic narcotics.

If the symptoms of withdrawal from narcotics appeared the proper treatment is required. They may start to appear as soon as a patient starts cutting off the source. There are several treatment options for addiction, and most would start with detoxification. While getting an inpatient treatment from a reputable rehab center may cost a lot of money, not to mention the physical discomforts one has to go through, it remains to be the most effective program to ensure complete recovery and long-term sobriety. There are also many insurance and social assistance programs that can help overcome short-term and long-term effects of narcotics, withdrawal symptoms and severe side effects of addiction.

Page Sources

  1. Michael Gabay, Federal Controlled Substances Act: Controlled Substances Prescriptions. 2013.
  2. Issuance of Multiple Prescriptions for Schedule II Controlled Substances. Diversion Control Division.
  3. Jeanne M. Manubay, Carrie Muchow, Maria A. Sullivan, Prescription Drug Abuse: Epidemiology, Regulatory Issues, Chronic Pain Management with Narcotic Analgesics. 2012.

Published on: October 11th, 2019

Updated on: October 26th, 2020

About Author

Nena Messina, Ph.D.

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.


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