What Scheduled Drugs Can NPs Prescribe in Texas?

A Texas nurse practitioner with a valid Prescriptive Authority Agreement can prescribe controlled substances on Schedules III, IV, and V. Schedule II is far more restricted and is only available in hospital inpatient care, hospital emergency departments, or hospice care for a patient with a terminal illness. Schedule I substances cannot be prescribed by anyone. Those are the categories; the conditions attached to each are where the real rules live, and they decide what the question “what scheduled drugs can NPs prescribe in Texas” actually looks like in a clinic on a Tuesday afternoon.

Schedules III, IV, and V in Everyday Practice

An NP operating under a Prescriptive Authority Agreement may prescribe Schedule III, IV, and V controlled substances, but the total supply, including any refills, cannot exceed 90 days.¹ The Texas Medical Board treats the 90 days as a quantity cap, not a cap on the number of refills. You can write a prescription with multiple refills so long as the combined supply stays inside that window.

Every refill of a controlled substance requires a documented consultation with the delegating physician, and that consultation has to be noted in the patient’s chart.¹ This gets missed often. The consultation rule applies to every refill, not just refills that push the supply past 90 days. A separate rule applies to patients under age two: any controlled substance prescription for a child in that age group requires physician consultation before the NP writes it, documented in the chart.

Within those limits, the practical categories look like codeine combination products on Schedule III, alprazolam and diazepam on Schedule IV, and low-dose codeine cough preparations on Schedule V.² Nothing in state law forces a physician to delegate all of these; the PAA itself can carve out categories the physician does not want the NP writing, and those carve-outs bind the NP regardless of what state law would otherwise allow.

Schedule II: Hospital and Hospice Only

Texas draws a hard line at Schedule II. An NP cannot prescribe Schedule II controlled substances in a typical outpatient clinic, private practice, urgent care, or retail health setting. The only three settings where it is permitted are:

Hospital inpatient care, where the patient has been admitted for an intended stay of 24 hours or more and the prescription complies with the hospital medical staff’s policies.
A hospital emergency department, for a patient receiving emergency services.
Hospice care, where the patient has a terminal illness, has signed a written certification of that illness, has elected hospice, and is being treated by a qualified hospice provider.

In every one of those settings the NP’s authority still flows from the delegating physician’s supervision.³ For hospital-based Schedule II prescribing, the prescription also has to be filled through the hospital’s pharmacy and follow policies approved by the hospital’s medical staff or a designated committee.

The clearest illustration of how narrow this is came in 2014, when the DEA moved hydrocodone combination products from Schedule III to Schedule II. Medications NPs had been prescribing routinely in outpatient settings became off-limits outside the hospital and hospice contexts above. The Texas Board of Nursing confirmed that NPs may only prescribe hydrocodone combination products in those limited settings.⁴

Schedule I

No practitioner, NP or otherwise, can prescribe Schedule I substances. They are classified as having no accepted medical use.²

The Prescriptive Authority Agreement Behind All of It

None of the prescribing authority above exists without a Prescriptive Authority Agreement. Texas law requires a written, signed agreement between the NP and a delegating physician before the NP can prescribe or order any drug or device, controlled or not.⁵ The agreement has to identify both parties and their license numbers, describe the practice and its locations, specify the categories of drugs the NP may and may not prescribe, and lay out a plan for physician consultation, referral, and emergencies.

The delegating physician must register the prescriptive authority delegation with the Texas Medical Board. That registration matters for a practical reason: the DEA checks it before issuing the NP a DEA number, and an unregistered delegation will stop a DEA application in its tracks.⁴

Checking the Prescription Monitoring Program

Before writing a prescription for an opioid, benzodiazepine, barbiturate, or carisoprodol, every Texas prescriber has to check the state’s Prescription Monitoring Program.⁶ NPs are included. Skipping the check is grounds for board discipline.

Three exceptions exist. The PMP check is not required when the patient has cancer, has sickle cell disease, or is receiving hospice care, and in each case the prescriber must note the applicable diagnosis or hospice status in the prescription record.⁶ A prescriber who makes a good faith effort to access the PMP but cannot because of a system outage or similar circumstance is also excused.

DEA Registration and the One-Time MATE Training

An NP who prescribes controlled substances needs an active DEA registration. Texas eliminated its separate state-level Department of Public Safety controlled substances registration in 2016, so the DEA registration is the only controlled-substance-specific credential required.⁷ The registration runs on a three-year cycle, with a published practitioner fee of $888 per cycle in the most recent schedule; verify the current amount with the DEA when you apply.

The Consolidated Appropriations Act of 2022 added a one-time eight-hour training requirement for DEA-registered practitioners other than veterinarians, often called the MATE Act requirement, covering treatment and management of patients with opioid and other substance use disorders.⁸ NPs who graduated from an accredited advanced practice nursing program within five years of June 27, 2023 and whose curriculum included at least eight hours of substance use disorder content are considered to have met it. Others complete the training through accredited providers such as the American Association of Nurse Practitioners or the American Nurses Credentialing Center. The obligation is one-time; once completed and affirmed at a DEA renewal, it does not recur.

Prescribing Controlled Substances by Telehealth

Federal law normally requires at least one in-person evaluation before any practitioner, NPs included, can prescribe a controlled substance by telehealth. That rule comes from the Ryan Haight Act. The DEA has extended COVID-era telehealth flexibilities through December 31, 2026, so an NP can currently prescribe Schedule II through V controlled substances via telehealth without a prior in-person visit.⁹

To rely on that flexibility the prescription must be for a legitimate medical purpose, issued over real-time audio-visual communication rather than a phone call or text, and consistent with every other federal prescribing rule. Texas restrictions still apply on top of the federal rule. An NP seeing a patient by telehealth still cannot prescribe Schedule II drugs outside the hospital and hospice settings described above. The in-person evaluation requirement will likely return for new telehealth patients in 2027 when the extension expires, so plan patient workflows accordingly.

1
Texas State Board of Pharmacy. Information on Controlled Substance Prescriptions From APRNs and PAs
2
Office of the Law Revision Counsel. 21 USC 812 – Schedules of Controlled Substances
3
Texas Medical Board. Who Can Prescribe Schedule II Drugs Under Physician Delegation
4
Texas Board of Nursing. APRN Practice FAQ
5
State of Texas. Texas Occupations Code 157.0512 – Prescriptive Authority Agreement
6
State of Texas. Texas Health and Safety Code 481.0764 – Duties of Prescribers, Pharmacists, and Related Health Care Practitioners
7
Texas Medical Board. Prescribing and Supervision
8
U.S. Department of Justice Drug Enforcement Administration. DEA Registered-Practitioners – One-Time MATE Training Requirement
9
Federal Register. Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications