Drug law violations account for most instances in which physicians lose their medical licenses or go to jail. Drug law enforcement against physicians is often done by the same agents who pursue drug dealers. These agents do not show the same deference to physicians as do boards of medical examiners’ investigators.

Drugs are a particularly touchy area for NPPs. The states vary widely in the laws governing prescribing and dispensing drugs; some allow limited prescribing by nurse practitioners or physician’s assistants, but many do not. Some laws are inconsistent. Pharmacy laws may allow prescribing or dispensing by individuals who are prohibited from this by the medical or nursing practice act. A physician should not allow an NPP to write prescriptions without a clear understanding of the applicable state laws and should not allow dispensing except under strict protocol.

Office dispensing has been very informal in the past, but heightened awareness of the role of prescription drugs in drug addiction is causing states and the federal government to tighten drug laws and their enforcement. For example, the federal regulations on distributing drug samples are much more restrictive than in the past. A physician must provide detailed information on a form mandated by the Food and Drug Administration (FDA) before the drug company representative may leave samples of prescription drugs. These samples must be kept secure and dispensed in the same manner as other prescription drugs. Some states require samples to be dispensed personally by physicians.

Physicians should contact their state board of pharmacy and local office of the Drug Enforcement Administration (DEA) to obtain a copy of the restrictions on prescribing drugs. If a clinic or physician group plans to buy drugs in bulk and package them for dispensing, it should inquire about a pharmacy or dispensing license and a federal repackaging permit. Most states allow physicians to dispense drugs if they bottle and label the pills personally and give them to the patient directly, but the state and federal government also impose substantial recordkeeping requirements on physicians who do this.