State medical boards should make decision on nonphysician prescribing

Regarding "NP: Physicians don't have a monopoly on concern over patient safety"(Letters, Feb. 28): Currently, Kentucky has a bill before the state Legislature that would let nurse practitioners prescribe narcotics -- this in a state well known for its MS Contin abuse and meth labs and with marijuana surpassing tobacco as the No. 1 cash crop.

The argument of letter author David Kleberger, NP, of Commerce City, Colo., that he cares about patients as much as any physician may be true, and I have no reason to suspect he would abuse any prescribing ability he might gain in the future. But legislating the "handing out the keys to the candy store" or making it easier for patients to acquire and/or divert prescription drugs by giving extender providers the ability to prescribe narcotics (or any other drug) is not how society should keep a grip on potentially dangerous substances.

This should be a medical decision, not a government, legal decision. If it is deemed necessary to allow extender providers full prescribing rights, then the next logical question is, why not pharmacists, psychologists, social workers, RNs, EMTs, etc.? Certainly PAs should be included if NPs are given these rights.

Continuing along this line of reasoning, members of the lay public could then demand full access to any FDA-approved medication. Why not have all meds OTC? The consumer can go online, read up on what they want or what they think will help them, walk down to Wal-Mart, Rite-Aid or CVS and just buy what they want. They could save money by not having a co-pay, or the government would save on Medicaid office visits.

This is a matter of training, trust, experience and ability. Not all physicians should be allowed to prescribe certain medications. NPs and PAs are no different.

Some, like Mr. Kleberger, I'm sure, have the experience and competence to be able to appropriately prescribe some classes of medications. But who decides and how it is accomplished are not things that should be legislated -- they are things that should be decided by good medical practice and oversight by the state medical board and licensing agencies. There has always been a mechanism in any state whereby extender providers can write for controlled substances -- it's called medical school.

William M. Bone, MD, PhD, Madisonville, Ky.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/04/11/edlt0411.htm.