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Ms. ML is currently on two control substances which are Diazepam (TID) and Norco (maximum 5 times/day) for pain control and the overlapping of using these two medications can severely depress the respiratory and central nervous system which can lead to fatal consequences (Vodovar, et al., 2022); hence, as her healthcare provider, I would educate Ms. ML about the interval frequency of taking the two medications to prevent the adverse effects. The NP should emphasize that mixing narcotic agents with alcohol can cause life-threatening events, especially since Ms. ML is taking care of her grandchild and can cause harm to her grandchild. Moreover, Norco has acetaminophen which can damage the liver when used with alcohol so the NP should explain to Ms. ML this fact (American Addition Centers, 2023a)

• To ensure patient and family safety, I’d schedule Ms. ML’s pain medication to prevent overlapping, as well as recommend physical therapy to improve her daily function. Also, I would recommend urine drug testing for Ms. ML as the Centers for Disease Control and Prevention’s advice for patients on chronic opioid therapy (CDC, 2016). 
• Pain contract suit Ms. ML’s pain management and safety concerns 

Pain and pain treatment are different for each person. My prescriber will routinely check how I am doing and educate me about the side effects to determine whether the benefits of opioid medicines outweigh the side effects of continuing to use them (Food and Drug Administration, n.d.).

Opioid medicine can impair my judgment and responses.  I understand that I must be cautious and alert to ensure sure I can perform daily activities safely (FDA, n.d.)

Safe Prescribing

1. The APRN in CA needs to register with the Controlled Substance Utilization Review and Evaluation System (CURES) and acquire the Federal Drug Enforcement Administration Controlled Substance Registration certificate.

The APRN in Massachusetts (MA) needs to follow the regulations from the MA Department of Public Health (DPH), register with the United States Drug Enforcement Agency (DEA), and obtain the prescriptive authority from the Massachusetts Controlled Substance Registration (MCSR) (Commonwealth of Massachusetts, 2015). 

To ensure safety in prescribing medications, I’d review the patient’s medical history, and physical and neurological assessments, identify potential drug-drug and drug-food interactions, and educate the patient about compliance with medication dosage and frequency. Moreover, I’d consult advice and approval from supervision.

The state of California does not allow a Schedule II to be refilled (CA BOP, 2023). Controlled Substances III can be refilled up to 5 times with a 120-day total supply of refills (CA BOP, 2023). 

1. MA allows Controlled Substances II and Controlled Substances III to have a 30-day supply and cannot be refilled (Mass.gov, 2020). However, for patients with brain dysfunction or narcolepsy, Methylphenidate and Dextroamphetamine sulfate (both are CII) can have a 60-day supply (Mass.gov, 2020).

Losartan, Gabapentin, and Atorvastatin can be prescribed via electronic order. I’d write written prescriptions for Norco and Diazepam for Ms. ML. Elements should include my name, my facility, my supervisor, date, controlled substance information including name, dosage unit, quantity to be dispensed, instructions for use, caution (if needed), number of times to be refilled, and Ms. ML full name and address.

Immediately after the controlled substance is prescribed, the NP should report to the state registry using the Massachusetts Prescription Awareness Tool (MassPAT).

The NP with restricted authorization needs to follow the standardized protocol as the following approach (BoRN, n.d.)

Acquire a certificate from the Board of Registered Nursing and a Drug Enforcement Administration registration number.

1. The controlled substances ordered need to be approved by the treating physician or supervising physician.  

Furnish the drug based on which categories of patients may be furnished this class of medications.

The protocol may include the limit amount to be furnished or the criteria for consultation.

1. References
2. American Addition Centers. (2023a). Mixing Norco and Alcohol. Retrieved from https://alcohol.org: https://alcohol.org/mixing-with/norco/
3. American Addition Centers. (2023b). The Effects of Mixing Diazepam and Alcohol. Retrieved from https://alcohol.org: https://alcohol.org/mixing-with/diazepam/

BoRN. (n.d.). CRITERIA FOR FURNISHING NUMBER UTILIZATION BY NURSE PRACTITIONERS. Retrieved from https://www.rn.ca.gov/: https://www.rn.ca.gov/pdfs/regulations/npr-i-16.pd…

• CA BOP. (2023). Frequently Asked Questions. Retrieved from https://www.pharmacy.ca.gov: https://www.pharmacy.ca.gov/publications/faq_askin…
• CDC. (2016). .CDC Guideline for Prescribing Opioids for Chronic Pain – Urine Drug Testing. MMWR .
• Commonwealth of Massachusetts. (2015). PRESCRIBING PRACTICES POLICY AND GUIDELINES.Wakefield: Board of Registration in Medicine.
• Food and Drug Administration. (n.d.). Opioid Patient Prescriber Agreement (PPA). Retrieved from https://www.fda.gov: https://www.fda.gov/files/drugs/published/Opioid-P…

Mass.gov. (2020). Mass. General Laws c.94C § 23. Retrieved from https://www.mass.gov: https://www.mass.gov/info-details/mass-general-law…

Vodovar, D., Chevillard, L., Caillé, F., Risède, P., Pottier, G., Auvity, S., . . . Tournier, N. (2022). Mechanisms of respiratory depression induced by the combination of buprenorphine and diazepam in rats. Respiration and the Airway.