Can an NP prescribe Hydrocodone in North Carolina?

Yes, but only with required authorization — a North Carolina NP may prescribe hydrocodone only if the NP’s collaborative practice agreement authorizes Schedule II controlled-substance prescribing, the NP has DEA registration and the primary supervising physician’s controlled-substance schedules are equal to or greater than the NP’s DEA registration.¹ The NP also must have active North Carolina NP approval with prescriptive authority and prescribe within the NP’s population focus, education, national certification, and competence. Hydrocodone is a Schedule II opioid and targeted controlled substance under North Carolina law.²

For an initial acute-pain prescription, the STOP Act caps hydrocodone at 5 days, or 7 days for immediate post-operative acute pain; those acute-pain caps do not apply to chronic pain or pain treated as part of cancer care, hospice care, palliative care, or medication-assisted treatment for substance use disorder.³

Before initially prescribing hydrocodone, and every subsequent three-month period while it remains part of care, the NP must review and document CSRS unless an exception applies; CSRS review is optional for targeted controlled substances administered in certain care settings or prescribed for cancer-related, hospice, or palliative care.⁴ Meaningful, documented consultation with the supervising physician is also required before targeted controlled-substance prescribing in qualifying pain-management settings when use is expected to exceed 30 days, and at least every 90 days when a targeted controlled substance is continuously prescribed outside pain-management settings.⁵

North Carolina NPs may not prescribe controlled substances for themselves, their supervising physician, immediate family members, household members, or intimate partners, and Schedule II controlled substances may not be refilled.