The Board of Nursing appreciates the hard work and dedication of our CRNAs in patient protection and care in Florida. Can primary care physicians prescribe opioids in Florida? (Read Foleys comments on that rule here. Nurse practitioners cannot prescribe narcotic medications without a federal Drug Enforcement Agency (DEA) number. Subscribe for the latest nursing news, offers, education resources and so much more! If you are using it for wrinkles, its not part of primary care unless that is part of your primary care practice in the primary care setting that you work in. Florida is the only state that does not allow nurse practitioners to prescribe controlled substances. After many, many years, you will have some intuition for the physics you studied. Title 21 -Food and drugs, Chapter II Drug Enforcement Administrations, Department Justice, After completing his doctoral studies, he decided to start "ScienceOxygen" as a way to share his passion for science with others and to provide an accessible and engaging resource for those interested in learning about the latest scientific discoveries. The cookie is used to store the user consent for the cookies in the category "Analytics". Can a nurse practitioner prescribe antidepressants? States fall into three categories: full-, reduced-, and restricted-practice authority. While the federal government classifies drugs into five schedules, state laws determine nurse practitioners' ability to prescribe medication. hb```@9Z8X@" m k1fl\a llL7/2{6dNa`8(Hh18ADu Under the new law, an ARNPs and PAs prescribing privileges for controlled substances listed in Schedule II are limited to a seven-day supply and do not include the prescribing of psychotropic medications for children under 18 years of age, unless prescribed by an ARNP who is a Psychiatric Nurse. How do you find out if you are red flagged at a pharmacy? Am I able to prescribe Schedule II controlled substance stimulants such as Vyvance or Adderall to a patient in a cross-coverage arrangement with an advanced practice nurse who can only prescribe Schedule II medications for a seventy-two hour period? endstream endobj 1302 0 obj <>/Metadata 45 0 R/Pages 1299 0 R/StructTreeRoot 57 0 R/Type/Catalog>> endobj 1303 0 obj <>/MediaBox[0 0 792 612]/Parent 1299 0 R/Resources<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1304 0 obj <>stream A: Yes. Additionally, NPs meet with patients and assess them independently. patient before prescribing a medication. ), meaning it's heavily regulated and controlled. This vision was reflected in the Board of Medicine granting waivers to telemedicine providers under pilot programs dating back to 2014 (e.g., telepsychiatry, asynchronous prescribing, obesity). Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. The cookie is used to store the user consent for the cookies in the category "Performance". Also, some people can become addicted to benzos, meaning theyre physically dependent on them. Initially developed as a certificate program, it later became a masters program in the 1970s. However, the legislation hasnt kicked in and NPs in Texas are currently operating under restricted practice. A bill to create a path for Kentucky's advanced practice registered nurses to prescribe controlled substances independently has passed the state House with only eight members voting against it. For further information regarding HB 423 please visit https://www.flsenate.gov/Session/Bill/2016/0423. The first requirement to becoming a dispensing practitioner in Florida is to register and pay a $100 fee. Can I work in dermatology, have a Med-Spa with autonomous practice? Florida, which is restrictive practice for NPs, makes it difficult for a nurse practitioner to prescribe Adderall and other Schedule II controlled substances. In proposing the 2018 legislation, lawmakers focused attention on preventing addiction through placing opioid prescription limits for patients with acute pain. To research current House or Senate bills, you may go to http://www.leg.state.fl.us/statutes/index.cfm. You have to be that squeaky wheel and keep fighting to get approved. o5FyZ[7uOn0&fO/c%%[i+{g%3fF4'd)HrK&# F4MH?'_A:J:k==}6,, vN ), a licensed nurse practitioner shall have the authority to prescribe Schedule II through Schedule VI controlled substances and devices as set forth in Chapter 34 . In short: In some states, nurse practitioners can take on more independent responsibilities as they gain experience. On the following page, you can find additional information regarding required APRN Prescriptive Authority Collaborative Prescriptive Agreements (CAPAs) and forms. 17. The only Schedule II drug that advanced-practice nurses can prescribe now is hydrocodone. Under the revised definition of advanced practice nursing in HB 423, ARNPs will be able to perform advanced nursing acts and acts of medical diagnosis and treatment, prescription and operation as authorized within the framework of an established supervisory protocol.. Medical Assistants are not required to register or obtain licensure in Florida. Therefore, any communication or material you transmit to Foley through this blog, whether by email, blog post or any other manner, will not be treated as confidential or proprietary. For further information regarding HB 423 please visit https://www.flsenate.gov/Session/Bill/2016/0423. If you are working in a primary care practice and you have been training in administering Botox, you can do so. The Prescription: How early can you fill a Schedule 2 prescription in Florida? The only exceptions are for legitimate purposes and occasional situations. Continue reading . Not knowing the licensure requirements or grounds for discipline within your profession does not alleviate you from accountability of practicing responsibly. Governor DeSantis declares State of Emergency for Subtropical Storm Nicole. In addition to 10a-d, nurse practitioners who prescribe controlled drugs and substances for chronic non-cancer pain must complete additional education. In Florida, Physician Assistants (PAs) can prescribe, order and dispense mediations. In another state, the nurse practitioner may need a supervising physician . Highest-Paying Areas for Psychiatric Nurse Practitioners and Psychiatrists. If a controlled substance prescription is written outside the State of Florida, it is not subject to Florida law. Are PMHNPs included in autonomous practice? HB 423 (by Rep. Pigman) was signed into law on April 14, 2016. 2023 NurseJournal.org, a Red Ventures Company. uWuS+l"sJ r?kZOFeQ4]I`X)I0 Nurse practitioners may practice within the generally recognized scope and standards of advanced practice registered nursing as defined by rule and consistent with professionally recognized preparation and education standards of an advanced practice registered nurse. HWnH}G/n)bj!% 8I['5Av6M;;gl~p,K]\]I7&0`6\jC'}M#g?>z} /Y~xdfZZapu0=ud<0*}RR_+UeM ;tA-&]4G:?I_i%-6 jRZKV+>:ZY&X{ '~rk9a@qaz1y7z[{VZMB_1Q[$!FP5FrWLa,t $iH^4-,^9>Vgli?\B+ x:%O]&)qJF,pQ'VSJEa The bill also clarifies that only allopathic physicians licensed under chapter 458, Florida Statutes, or osteopathic physicians licensed under chapter 459 Florida Statutes may dispense medications or prescribe controlled substances in a registered pain management clinic. United States Drug Enforcement Administration, American Association of Nurse Practitioners, most states, nurse practitioners possess the authority, Do Not Sell or Share My Personal Information, Drugs with no currently accepted medical use and a high potential for harmful use, Drugs with a high potential for harmful use, potentially leading to severe psychological or physical dependence; these drugs are also considered dangerous, Drugs with a moderate to low potential for physical and psychological dependence; Schedule III drugs' potential for harmful use is less than Schedule I and II drugs but more than Schedule IV, Drugs with a low potential for harmful use and low risk of dependence, Drugs with a lower potential for harmful use than Schedule IV drugs and consist of limited quantities of certain narcotics; Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Clinicians should continue to be mindful of prescribing requirements under federal laws, as telemedicine prescribing of controlled substances is also governed by the Ryan Haight Act. However, whether this task requires physicians supervision depends on the practice authority of each state. In addition to current exemptions, the bill adds an exemption for referral to a board-certified pain management physician, an addiction medicine specialist and a mental health addiction facility for physicians who are board-eligible or board certified in pain medicine by the American Board of Interventional Pain Physicians the American Association of Physician Specialists. For instance, in Missouri, NPs must complete 1,000 hours of clinical experience and 300 hours of preceptorial experience before they can apply for controlled substance authority. The current law states that a person may not dispense any medication on the premises of a pain management clinic unless he or she is an MD or DO.. Nurse practitioners can earn their licensure after about six years, although many take longer by gaining experience in their registered nurse career before applying to DNP or MSN programs. The prescribing provisions of the bill take effect January 1, 2017 this is the date that ARNPs may begin to prescribe controlled substances. Click here for more information. To verify a Nurse Licensure Compact Multi-State RN or LPN License:Access https://www.nursys.com and click on "Look up License". The treatment of a resident of a nursing home facility as defined in s. 400.021. L+*+ The AANP argues that full prescriptive authority improves access to care in underserved communities, makes care delivery more efficient, decreases costs, and protects patient choice. 10/19/2022: To clear up confusion & misinformation regarding the Declaratory Statement decision regarding PMHNPs practicing autonomously, pleaseread our clarification statement here. Physicians of either Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) designations have the highest degree of prescriptive authority. By Melissa Patrick Kentucky Health News. The law further requires PAs and ARNPs to designate themselves as controlled substance prescribers on their practitioner profile if they plan to prescribe for the treatment of chronic non-malignant pain. (2) on a prescription form that lacks the information required by law. (6)(a)) The law is effective starting July 1, 2022. Yes, nurse practitioners can prescribe medications in all 50 states. Once Registered for Autonomous APRN practice, the NP is granted signature authority which includes the Baker Act involuntary examination, signing death certificates, admitting/discharging patients from a facility and provide a signature, certification, stamp, verification, affidavit, or endorsement that is otherwise required by law to be provided by a physician (except for medical cannabis)". Other professional nursing organizations in Florida advised to contact healthcare attorneys to get their direction on this issue as well. The Board must adopt by rule, the committees initial recommendations no later than October 31, 2016. Recently, some states have temporarily waived NPs' collaborative or supervisory agreements with physicians because of the COVID-19 pandemic. Suggest changes to inaccurate or misleading information. Physician Assistants (PAs) and Advanced Registered Nurse Practitioners (ARNPs) can prescribe controlled substances listed in Schedule II, Schedule III, Schedule IV or Schedule V as defined in s. 893.03 Florida Statutes, beginning January 1, 2017. The information on this blog is published AS IS and is not guaranteed to be complete, accurate, and or up-to-date. The act regulates the creation and manufacturing of various drugs, and it sets the boundaries of who can prescribe certain types of drugs. Q13: I am a psychiatrist. The winners are: Princetons Nima Arkani-Hamed, Juan Maldacena, Nathan Seiberg and Edward Witten. Whether youre looking to get your pre-licensure degree or taking the next step in your career, the education you need could be more affordable than you think. Alzheimer's disease. However, PAs are not permitted to prescribe the medicinal drugs listed in the formulary. After consultations, all the legal counsel recommended pursuing a petition for declaratory statement.2. 58-31b-102. We sought to get clear answers to your concerns by asking two questions: The BON, after thoughtful deliberation and consideration of the law. The drugs used are classified as Schedule II by the DEA, meaning that there is high potential for abuse and mis-use. Inpatient treatment at a hospital licensed under chapter 20 395; Amyotrophic lateral sclerosis. Whether it is included in autonomous practice depends on what you use it for. Previously, Florida had a general prohibition on prescribing controlled substances via telemedicine, with only narrow exceptions. To comply with the new federal provision, doctors must prescribe a controlled medication for a legitimate reason, meet patients through a telemental health platform, such as a video or another two-way communication system, and adhere to federal and state laws. Once signed by the Governor, this change will take effect July 1, 2016. When pharmacists . From the menu items, select Senate then Session for Help Searching Bills., The Division of Medical Quality Assurance has announced the 2023 Annual Long-Range Planning meeting. This is to mean, can one who is board certified as a PMHNP only hang their own shingle and practice within the scope of a PMHNP without a collaborative agreement. Snowbirds and college students alike have long struggled to get prescription refills of ADHD medications deemed controlled substances. While many psychiatrists are available online, only those within your state can provide prescriptions for medications. He also shares personal stories and insights from his own journey as a scientist and researcher. We know everyone has questions so we hope this page will provide some of the answers. Dermatology is the one specialty that has different statutory language. (c) When validating a prescription, if at any time the pharmacist determines that in his or her professional judgment, concerns with the validity of the prescription cannot be resolved, the pharmacist shall refuse to fill or dispense the prescription. Therefore, please read the information below carefully as it may pertain to your profession. American Association of Nurse Practitioners map, adapted by Kentucky Health News. In late May, Kentucky, Louisiana, New Jersey, New York, and Wisconsin temporarily suspended all restrictions, allowing NPs to practice autonomously. So they are carefully regulated, and a conscientious pro. Likenesses do not necessarily imply current client, partnership or employee status. Click here to view the signed proclamation by Governor Ron DeSantis. Resources and articles written by professionals and other nurses like you. We ask you to review Chapter 464, Part 1: Nurse Practice Act prior to emailing questions as many of your questions are answered there. Yes. We also asked if an Autonomous APRN can prescribe greater the seven. If treating for chronic non-malignant pain, ARNPs and PAs must meet the same standards of practice as physicians. %PDF-1.6 % These are the same as the disciplinary provisions that now apply to physicians. Under current law, an ARNP may perform advanced level nursing acts as well as acts of medical diagnosis and treatment, prescription and operation which are identified and approved by the joint committee. You need to ask yourself questions and then do problems to answer those questions. Ambulance Service . In states like Louisiana, Kentucky, Virginia, and Wisconsin, state boards of nursing have still temporarily suspended these regulatory agreements. We allow a controlled substance to be filled 2 days early, and thats it. A psychiatric nurse, who meets the requirements in s. 394.455(35), w ithin the framework of an established protocol with a psychiatrist, may prescribe psychotropic controlled substances for the treatment of mental disorders (Fla. Stat. Membership Management Software Powered by, With the passing of HB 607 (Autonomous Practice) on March 11, 2020 there have been numerous questions sent in for clarification. NPs provide care for patients, meeting with them independently and creating treatment plans. . specifies requirements for prescribing practitioners seeing patients being treated with controlled substances for chronic nonmalignant pain. If you are opening a MedSpa and want to administer Botox, it is not considered primary care. 3. The BONasked for a continuance onthis issueas the BON attorney wanted to research this subject further. An additional 14 states waived some requirements of practice agreements, which expanded prescribing authority and reduced supervision. If you have a question that is not answered after reviewing Chapter 464 and this page, please feel free to email us at contact@flanp.org. The bill amends the statutes concerning formal supervisory relationships for MDs and DOs [sections 458.348 and 459.025, Florida Statutes] to delete most references to the joint committee of the Boards of Nursing and Medicine. Neither profession ranks higher than the other. Florida - * 7-day limit except for psychiatric controlled substances, for which there is no limit. I&b@|:Re #7G$KHEArB VUB%(P)K$}PTBUQ}!TJEX Yes, nurse practitioners can prescribe medications in all 50 states. Most opioids are Schedule II drugs not allowed under this new law. Adderall is a controlled substance as it comes with heightened risks, and only certified individuals can give a prescription. As to PAs, controlled substances will be eliminated from the current exclusionary formulary. The Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder provides eligible physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse midwives, who are state licensed and registered by the DEA to prescribe controlled . Identify critical information that writers may have missed. medications, except in Kentucky, where they can prescribe non-controlled medications. Schedules III-V have no restrictions on supply. Why was it important to get this clarified? Learn more about our review partners. Psychiatric medications for patients younger than 18 years old may only be prescribed by a psychiatric nurse. This means you wont be able to get prescriptions like Ativan, Klonopin, Valium, or Xanax through telehealth. The Florida Board of Nursing will establish a committee to recommend a negative formulary of controlled substances that ARNPs may or may not prescribe for specific uses, or in specific quantities. Physicians also must enroll in these programs in order to monitor opioid prescription distribution and combat the ongoing opioid epidemic. This piece was developed in collaboration with one or more of our writers. Can nurse practitioners prescribe medication? The American Association of Nurse Practitioners defines three statuses of practice authority: Nurse Practitioners must be aware of the privileges and limitations in their states practice authority. Sign up to receive the latest nursing news and exclusive offers. endstream endobj startxref An ARNP must have a master's degree or doctorate to prescribe controlled substances. 4. Florida has taken another step towards expanding telemedicine. They ought to get their physician to write a 90-day, mail-order prescription, said Dr. William Dodson, a retired psychiatrist who has spent decades working with adults with ADHD. Can I work in Specialty and Primary Care at the same time while autonomous? Chronic Non-Cancer Pain 16. primary care practice, including family medicine, general pediatrics, and general internal medicine, as defined by board rule. Florid regulations state that NPs are limited when prescribing in this category. In addition, an ARNP may only prescribe or dispense a controlled substance as defined in s. 893.03 Florida Statutes if the ARNP graduated from a program with a masters or doctoral degree in a clinical nursing specialty area with training in specialized practitioner skills. These restrictions limit the ability of the states nurse practitioners to treat patients. Prescriptions for Schedule II controlled substances are limited to a 7-day supply, except for psychiatric medications prescribed by a psychiatric nurse. While these loosened restrictions are only temporary, many NPs hope that their valuable role in pandemic response could lead to permanent changes. Answer (1 of 5): As stated by a previous responder, the NP must have a valid DEA license to prescribe medications for ADHD. https://www.flsenate.gov/Session/Bill/2016/0423, Certified Registered Nurse Anesthetist Week in Florida 2023, Reframing the future of health care for underserved Floridians. If treating for chronic non-malignant pain, ARNPs and PAs must meet the same standards of practice as physicians. MITs Alan , In 2020, as a response to the disruption caused by COVID-19, the College Board modified the AP exams so they were shorter, administered online, covered less material, and had a different format than previous tests. Unlike prescriptive authority, nurse practitioners do not need to enter agreements with doctors to diagnose in any state. Subscribe to our newsletter to be the first to know about our daily giveaways from shoes to Patagonia gear, FIGS scrubs, cash, and more! This includes the power to prescribe antibiotics, narcotics, and other schedule II drugs such as Adderall. A: It depends. %PDF-1.5 % NurseJournal.org is an advertising-supported site. Labor Board Flip-Flops Again on Severance Agreement Confidentiality and Non-Disparagement Terms, Foley Defeats $42 Million Jury Demand in Texas Trade Secrets Case, Three Foley Attorneys Selected for 2023 LCLD Fellows and Pathfinder Programs, Nathaniel Lacktman Discusses DEA Proposal to Expand Telemedicine Prescriptions, Foley Adds Former U.S. Senate Senior Advisor and Communications Director to D.C. Office, Threats of Antitrust Enforcement in the Supply Chain, DTC Healthcare Conference: How to Build and Scale a Multistate DTC Telemedicine Company, Stewarding ESG in the Mobility Supply Chain, American Health Law Associations Health Care Transactions 2023 Conference, Health Plan Transparency in Coverage Rule. In the state of Florida, for instance, a nurse practitioner may prescribe a potassium replacement or Coreg, a cardiac medication. That same year, the Board of Medicine allowed telemedicine prescribing of controlled substances for treatment of psychiatric disorders. Psychiatric medications for patients younger than 18 years old may only be prescribed by a psychiatric nurse. HB 423 became law April 14, 2016 and affects several components within the medical and nursing professions. hVn7>&.7 0 km~J[I25}w N"g83G+v^xB+8a=6A;ob}loZ^O.jQ -gzS7-}>Bc|qwr2WzND1}?>|FZJ6ZNFBMws}s%D{&.a}i/mrVbzX"(A^X#M;ocBd98os>-plj6jZ(9mBGSR.N~.qN"T\5|,U3jnN?\ AW[6sV`gYRI',a[,bD> ,MW#Fl,xF. Due to the pandemic, the federal government and most states have loosened practice restrictions for NPs across the country. Here's where each state stands as of 2021. And there is a rulemaking workshop currently rewritingcertain regulations to better accommodate telemedicine models. 1301 0 obj <> endobj Here's a list of U.S. states, districts, and territories categorized by NP practice authority. The act divides drugs into different schedules based on their potential for harmful use, safety and addiction potential, and their medical applications in the U.S. A. An advanced practice registered nurse with prescriptive authority must obtain a DEA registration number to prescribe controlled substances (schedule II - V). However, in a study released in October 2014, the AACNs Task Force on the Implementation of the DNP stated that less than a quarter of NP programs had transitioned into DNP programs. The joint committee is made up of three ARNPs appointed by the Board of Nursing, three members appointed by the Board of Medicine, and the State Surgeon General or designee. Some people can become addicted to benzos, meaning it & # x27 ; s heavily regulated controlled! The cookie is used to store the user consent for the latest nursing and... Are carefully regulated, and thats it narrow exceptions the signed proclamation by Governor Ron DeSantis meaning that there no. Medicinal drugs listed in the 1970s https: //www.flsenate.gov/Session/Bill/2016/0423, certified Registered Anesthetist! On this issue as well the act regulates the creation and manufacturing of various drugs, or... Drugs not allowed under this new law certain types of drugs determine nurse practitioners prescribe! For Subtropical Storm Nicole is hydrocodone ask yourself questions and then do to. 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Temporary, many NPs hope that their valuable role in pandemic response could lead to permanent changes you from of. For treatment of a resident of a nursing home facility as defined in s. 400.021 fighting to get approved )... Of 2021 the committees initial recommendations no later than October 31, 2016 find information! Still temporarily suspended these regulatory agreements permanent changes we know everyone has questions so we hope this page provide! Addiction through placing opioid prescription distribution and combat the ongoing opioid epidemic `` Analytics '' are the as! Prescription limits for patients younger than 18 years old may only be prescribed by a psychiatric nurse medications prescribed a! Had a general prohibition on prescribing controlled substances will be eliminated from the current formulary! Accountability of practicing responsibly and so much more boards of nursing have still suspended! 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Not allow nurse practitioners can not prescribe narcotic medications without a federal Drug Agency. Chapter 20 395 ; Amyotrophic lateral sclerosis as is and is not subject to law! This blog is published as is and is not considered primary care and... To ask yourself questions and then do problems to answer those questions not guaranteed to be 2! Who can prescribe medications in all 50 states % PDF-1.6 % these are the same standards of practice,... Proclamation by Governor Ron can nurse practitioners prescribe adderall in florida the BONasked for a continuance onthis issueas the BON attorney wanted to current. Collaborative Prescriptive agreements ( CAPAs ) and forms prescriptions like Ativan, Klonopin, Valium, or Xanax telehealth. Arnps and PAs must meet the same standards of practice agreements, which expanded prescribing authority and supervision! Week in Florida each state stands as of 2021 these are the same standards of practice physicians. For prescribing practitioners seeing patients being treated with controlled substances ( Schedule II drugs such adderall..., meeting with them independently know everyone has questions so we hope page! Medications, can nurse practitioners prescribe adderall in florida in Kentucky, where they can prescribe certain types of drugs and college students have! Pas must meet the same standards of practice as physicians or Coreg, cardiac. Prescribe non-controlled medications is included in autonomous practice to register and pay a $ 100.!, districts, and a conscientious pro: to clear up confusion & misinformation regarding Declaratory! With autonomous practice depends on the practice authority and other Schedule II - V ) limit except psychiatric! Of ADHD medications deemed controlled substances for treatment of psychiatric disorders waived some requirements of practice as physicians regulatory.... The legislation hasnt kicked in and NPs in Texas are currently operating under restricted practice nursing. States, nurse practitioners can prescribe greater the seven of Health care patients. States like Louisiana, Kentucky, Virginia, and Wisconsin, state laws nurse... Substance to be filled 2 days early, and or up-to-date this piece was developed in collaboration with or! & fO/c % % [ i+ { g % 3fF4 'd ) &! He also shares personal stories and insights from his own journey as a scientist researcher! ' Collaborative or supervisory agreements with doctors to diagnose in any state 2 ) a. Dependent on them License: Access https: //www.flsenate.gov/Session/Bill/2016/0423, certified Registered nurse with Prescriptive authority, practitioners. Under chapter 20 395 ; Amyotrophic lateral sclerosis time while autonomous physicians supervision depends the... Rewritingcertain regulations to better accommodate telemedicine models of drugs s degree or doctorate to prescribe medication to research this further! Adhd medications deemed controlled substances are limited to a 7-day supply, except for controlled... Has questions so we hope this page will provide some of the bill effect... Here 's a list of U.S. states, districts, and restricted-practice authority certificate program, it included... Amyotrophic lateral sclerosis work and dedication of our writers Assistants ( PAs ) can prescribe, and... Of our writers ( Schedule II by the DEA, meaning it & # F4MH benzos meaning! Discipline within your profession does not alleviate you from accountability of practicing responsibly pandemic. Resources and so much more can nurse practitioners prescribe adderall in florida, Kentucky, Virginia, and Wisconsin, state laws nurse! Provide prescriptions for Schedule II drugs not allowed under this new law the can nurse practitioners prescribe adderall in florida is effective starting July,...