There is no single national list of medications that nurse practitioners cannot prescribe. What an NP can and cannot prescribe depends almost entirely on the state where they practice, because each state sets its own rules about prescriptive authority. In some states, NPs prescribe everything a physician can. In others, entire drug schedules or specific medication classes are off-limits without physician involvement.
The practical answer breaks down into a few major categories: controlled substances (especially the most tightly regulated ones), medical marijuana, certain medications restricted by state-specific “negative formularies,” and drugs that fall outside an NP’s collaborative agreement in states that require physician oversight.
How State Laws Shape Prescriptive Authority
Every state falls into one of three categories defined by the American Association of Nurse Practitioners. In full practice states, NPs can evaluate patients, diagnose conditions, and prescribe medications, including controlled substances, without any physician involvement. They operate under the authority of the state board of nursing alone. In reduced practice states, NPs must maintain a collaborative agreement with a physician throughout their career in order to prescribe. And in restricted practice states, NPs need direct supervision, delegation, or team management from a physician before they can provide care or write prescriptions.
The difference is enormous. An NP in Alaska can independently prescribe Schedule II through V controlled substances with no physician sign-off. An NP in Alabama can only prescribe Schedule III through V, meaning the most potent controlled substances (Schedule II) are entirely off the table. Texas takes a different approach: NPs there can prescribe Schedule II drugs, but only inside a hospital setting for admitted patients, emergency department patients, or people in hospice care. A Texas NP cannot write a Schedule II prescription intended to be filled at a retail pharmacy.
Schedule II Controlled Substances
The most common prescribing restriction NPs face involves Schedule II controlled substances. This category includes some of the most frequently prescribed medications in the country: opioid painkillers like oxycodone and hydrocodone, stimulants like amphetamine salts used for ADHD, and certain sedatives and anesthetics. Several states either prohibit NPs from prescribing these drugs entirely or impose tight conditions.
Florida, for example, limits NP prescriptions of Schedule II controlled substances to a seven-day supply. The state also maintains a “negative formulary,” a list of controlled substances that NPs either cannot prescribe at all or can prescribe only for specific uses or in limited quantities. Florida further restricts prescribing of mental health controlled substances to children under 18, allowing only psychiatric nurse practitioners to do so.
In Texas, the restrictions go beyond which drugs can be prescribed. Even when an NP has authority to prescribe controlled substances, they must consult with their supervising physician for refills after the initial 90-day supply, and every 90 days after that, as long as the patient remains on the medication. Freestanding emergency departments in Texas do not count as eligible sites for Schedule II prescribing, even if a hospital-affiliated ED does.
Arizona allows NPs to prescribe Schedule II through V controlled substances but carves out one specific exception: opioids used for medication-assisted treatment of substance use disorders, such as buprenorphine prescribed to treat opioid addiction.
Medical Marijuana Certification
Medical marijuana occupies a unique legal space because it remains a Schedule I substance under federal law, meaning no provider can technically “prescribe” it. Instead, states that have legalized medical marijuana allow providers to “certify” or “recommend” patients for its use. Most states restrict this authority to physicians only.
Only 17 states and the District of Columbia allow NPs to certify patients for medical marijuana. These include New York, Illinois, Massachusetts, Maryland, Colorado (limited to disabled patients), Virginia (limited to cannabis oil), and a handful of others. In every other state with a medical marijuana program, NPs cannot authorize its use regardless of their general prescriptive authority. Oregon’s Board of Nursing, for instance, has explicitly interpreted recommending cannabis as a physician-only function.
Medications Tied to Collaborative Agreements
In reduced and restricted practice states, the collaborative practice agreement between an NP and a supervising physician defines much of what the NP can prescribe. These agreements vary not just state to state but practice to practice. A collaborating physician might exclude certain drug classes from the agreement based on specialty, comfort level, or institutional policy.
This means two NPs in the same state could have different prescribing capabilities depending on what their individual agreements allow. Common exclusions in these agreements include chemotherapy agents, certain high-risk cardiac medications, and experimental or newly approved drugs that fall outside the NP’s area of training. If a medication isn’t covered by the agreement, the NP simply cannot prescribe it, even if state law would otherwise permit it.
Specialty-Specific Restrictions
An NP’s certification specialty can also limit their prescribing scope. Family nurse practitioners, adult-gerontology NPs, and psychiatric mental health nurse practitioners (PMHNPs) all operate within different clinical boundaries. A family NP would not typically prescribe psychiatric medications to a child, and Florida law makes this explicit by restricting mental health controlled substances for minors to psychiatric NPs only.
PMHNPs generally have broader authority to prescribe psychiatric medications, including Schedule II stimulants and certain sedatives, than other NP specialties. But even PMHNPs face the same state-level restrictions on controlled substances that apply to all NPs in their jurisdiction. A PMHNP in a state that bars NPs from prescribing Schedule II drugs cannot prescribe amphetamine-based ADHD medications regardless of their psychiatric training.
Federal-Level Requirements
Beyond state law, federal regulations add another layer. The DEA classifies nurse practitioners as “mid-level practitioners” alongside nurse midwives, nurse anesthetists, and physician assistants. To prescribe any controlled substance, an NP must hold a valid DEA registration, and the DEA defers to state law to determine what each NP is authorized to prescribe. If a state doesn’t grant NPs authority over a particular drug schedule, the DEA registration alone doesn’t override that.
Certain federally regulated medications also carry their own prescribing frameworks. Drugs with Risk Evaluation and Mitigation Strategies (REMS) require providers to complete specific certification programs before prescribing. While NPs can participate in these programs, the additional training and certification requirements can functionally limit access in practice, particularly in smaller or rural clinics.
What NPs Can Prescribe in Most States
Despite the restrictions, NPs in the majority of states can prescribe a wide range of medications that cover the bulk of primary care needs: antibiotics, blood pressure medications, diabetes drugs, cholesterol-lowering medications, antidepressants, anti-anxiety medications (Schedule IV), thyroid medications, inhalers, allergy treatments, and most non-controlled pain relievers. In full practice states, the list expands to include essentially anything a physician could prescribe, including Schedule II controlled substances.
The trend over the past decade has been toward expanding NP prescriptive authority, with more states moving into the full practice category. If you’re trying to determine what your NP can prescribe, the most reliable step is checking your state’s board of nursing website or the AANP’s state practice environment map, which categorizes every state’s current rules.