Nurse practitioners can prescribe a wide range of medications, including antibiotics, blood pressure drugs, antidepressants, insulin, inhalers, and in most states, controlled substances like opioids and stimulants. The exact scope depends on which state you’re in and whether that state requires a physician relationship for prescribing. As of 2025, 27 states plus Washington, D.C. and two U.S. territories grant NPs full practice authority, meaning they can prescribe independently without any physician oversight.
Medications NPs Commonly Prescribe
In day-to-day practice, nurse practitioners prescribe the same categories of medications that primary care physicians do. This includes prescription (also called “legend”) drugs, controlled substances, medical devices, and durable medical equipment like CPAP machines or glucose monitors. If you see an NP for a sinus infection, high cholesterol, diabetes, anxiety, or a skin rash, they can write prescriptions for the appropriate treatments just as a physician would.
Common examples include antibiotics for infections, statins for cholesterol, SSRIs for depression and anxiety, birth control pills, thyroid medications, blood thinners, and maintenance drugs for chronic conditions like asthma or high blood pressure. NPs working in specialty areas may also prescribe biologics, chemotherapy support medications, or psychiatric drugs depending on their training and certification.
Controlled Substances: Schedules II Through V
Federal law classifies nurse practitioners as “mid-level practitioners” who can prescribe controlled substances if their state authorizes it. To do so, an NP needs their own DEA registration number, which must appear on any controlled substance prescription. Most states allow NPs to prescribe Schedule II through V drugs, which covers everything from opioid painkillers and ADHD stimulants (Schedule II) to cough syrups with codeine and sleep aids (Schedules III through V).
The key variable is state law. Some states let NPs prescribe all controlled substance schedules independently. Others require a collaborative agreement with a physician before an NP can write for Schedule II drugs specifically, or they may cap the quantity or duration of certain controlled substance prescriptions. A handful of states still do not permit NPs to prescribe Schedule II medications at all without direct physician involvement.
How State Laws Shape Prescribing Authority
State-level rules fall into several categories, and the differences are significant. According to the National Conference of State Legislatures, the landscape breaks down like this:
- Full independent practice and prescribing: States like Alaska, Arizona, Hawaii, Idaho, Iowa, Kansas, Montana, Oregon, Washington, and Wyoming (among others) let NPs evaluate, diagnose, and prescribe with no physician relationship required.
- Transition period required: States like California, New York, Florida, Illinois, Connecticut, Virginia, and Maryland grant full independence after the NP completes a supervised transition period, typically ranging from a few hundred to a few thousand practice hours.
- Independent practice but physician relationship for prescribing: Kentucky and New Jersey allow NPs to practice independently in most respects but still require a physician relationship specifically for prescriptive authority.
- Physician relationship required: Texas, Georgia, Ohio, Pennsylvania, Michigan, North Carolina, Tennessee, and several other states require a career-long collaborative or supervisory agreement with a physician for both practice and prescribing.
If you’re a patient, this mostly matters behind the scenes. Your NP has already met whatever requirements your state demands before writing that prescription. But if you’re an NP or considering becoming one, the state you practice in dramatically affects your autonomy.
What Goes on the Prescription
An NP-issued prescription looks similar to a physician’s. It must include the NP’s name, their furnishing or prescriptive authority number (depending on the state), and their National Provider Identifier (NPI). For controlled substances, the NP’s individual DEA number is required. Pharmacies process NP prescriptions the same way they process physician prescriptions, and your insurance coverage doesn’t change based on who wrote it.
Opioid Use Disorder Treatment
One area that recently changed is prescribing buprenorphine for opioid addiction. Before 2023, any practitioner who wanted to prescribe buprenorphine needed a special DEA waiver (called an X-waiver), and there were strict caps on how many patients they could treat. The Consolidated Appropriations Act of 2023 eliminated that waiver requirement entirely. Now, any NP with a DEA registration that includes Schedule III authority can prescribe buprenorphine for opioid use disorder, with no patient caps.
There is one new requirement: NPs applying for or renewing their DEA registration must complete at least eight hours of training on substance use disorders, unless they graduated from an NP program within the past five years that included equivalent coursework. This change has expanded access to addiction treatment significantly, particularly in rural areas where NPs are often the primary prescribers.
Medical Cannabis Certification
Medical marijuana operates outside the standard prescription system because cannabis remains a Schedule I substance under federal law. Instead of writing a prescription, providers “certify” or “recommend” patients for a state medical marijuana program. As of recent counts, NPs can certify patients for medical cannabis in at least 17 states and Washington, D.C., including New York, Illinois, Massachusetts, Colorado, Maryland, Virginia, Hawaii, and several others. Some states have specific limitations. Colorado, for instance, only allows NP certification for patients classified as disabled, and Virginia limits NP authority to cannabis oil specifically.
Hospital vs. Outpatient Settings
State prescribing laws apply regardless of the clinical setting, but hospitals add their own layer of rules. When an NP works in a hospital, they’re subject to that facility’s credentialing process and formulary restrictions. A hospital may limit which medications any provider, including physicians, can prescribe based on its drug formulary. Some facilities restrict NPs from ordering certain high-risk medications or require co-signatures for specific drug categories, even in states with full practice authority. These are institutional policies, not state laws, and they vary widely from one health system to the next.
In outpatient clinics and private practices, NPs generally have broader day-to-day prescribing flexibility because they’re operating directly under their state license without an additional institutional credentialing layer. This is the setting where most NP prescribing happens, particularly in primary care, urgent care, and specialty clinics.