Can an NP prescribe Codeine in North Carolina?

It depends on the formulation and indication — a North Carolina NP may prescribe codeine only when the specific formulation falls within the NP's authorized controlled-substance schedules¹ and the NP has active North Carolina NP approval with prescriptive authority, prescribes within population focus, education, certification, and competence, and has a collaborative practice agreement identifying the applicable controlled-substance authority, DEA registration, and a primary supervising physician with controlled-substance schedules equal to or greater than the NP's DEA registration. Codeine's DEA schedule varies by formulation and dose, so the prescribing analysis depends on the product.²

For Schedule II or Schedule III opioid/narcotic codeine products that are targeted controlled substances, North Carolina STOP Act rules may apply. Initial acute-pain prescriptions are generally capped at 5 days, or 7 days for immediate post-operative acute pain, with statutory exclusions for chronic pain, cancer care, hospice care, palliative care, and medication-assisted treatment for substance use disorder.³

When the STOP Act applies, the NP may also need to review the CSRS before initial prescribing and every subsequent three-month period while the drug remains part of care, unless an exception applies, including certain administered-in-care-setting situations or cancer-related, hospice, or palliative-care prescribing.⁴ North Carolina also requires meaningful, documented supervising-physician consultation for targeted controlled-substance prescribing in specified pain-management and ongoing prescribing contexts.⁵ North Carolina NPs also may not prescribe controlled substances for themselves, their supervising physician, immediate family members, household members, or intimate partners.