PREPARING FOR PRESCRIBER EDUCATION: GETTING THE LAY OF THE LAND | 1

Preparing for Prescriber Education: Getting the Lay of 

the Land

Prescription opioid misuse remains a major issue for the prevention field

even as illicit fentanyl overtakes it as the largest driver of opioid-related 

overdose deaths.

1

In 2021, more than 8.8 million Americans misused 

prescription opioids2and approximately 1 in 5 fatal opioid overdoses 

involved prescription opioids.3

Prevention efforts focused on educating prescribers about opioids and alternative pain 

management techniques are an important strategy for reducing risk of opioid misuse and 

overdose. Prescriber education programs are effective in helping prescribers understand the 

complexities of treating chronic pain, including describing when and how to appropriately 

prescribe opioids.4

Prevention professionals can play an important role in both creating and supporting prescriber 

education programs. Before stepping into this arena, however, it is important to understand the 

environment in which these programs operate. For instance, there is considerable variation

across states in terms of how prescribers are licensed, monitored, and regulated. Taking the time 

to understand who can legally prescribe opioids, and the laws and requirements that regulate 

prescribing, can help practitioners target prevention programming and identify appropriate 

partners.

This tool is designed to help practitioners answer the following questions:

• Who is authorized to prescribe opioids in your state?

• Who issues prescriber licenses in your state?

• What educational programming or certifications do prescribers need to obtain a license 

to prescribe opioids?

Identifying Needs and Opportunities for 

Collaboration
PREPARING FOR PRESCRIBER EDUCATION: GETTING THE LAY OF THE LAND | 2

• Do opioid prescribers in your state need to adhere to continuing education 

requirements to renew a license?

• What prescriber education resources are already available?

• What collaboration opportunities exist to expand or improve prescriber education?

Q: Who is authorized to prescribe opioids in your state?

Across all states, only those prescribers registered at the federal level by the Drug Enforcement 

Administration (DEA) are legally permitted to write prescriptions for controlled substances, 

including opioids.5 A hospital or retail pharmacy can legally fill only those prescriptions written by 

prescribers who possess an active DEA registration.

The DEA recognizes two types of prescriber registrations: practitioners and mid-level 

practitioners.

1. Practitioners include doctors, dentists, veterinarians, and podiatrists. Practitioners have 

wide latitude to prescribe most classes of controlled substances as part of their federal 

DEA registration, including all Schedule II through V drugs.5

2. Mid-level practitioners include physician assistants, nurse practitioners, nurse 

midwives, nurse anesthetists, and registered pharmacists, among others. Mid-level 

practitioners have less latitude; their prescribing regulations are determined at the state 

level and there is wide variation across states. Some states, like Nevada, grant broad 

prescribing abilities to mid-level practitioners like physician assistants. Others, like 

Kentucky, prohibit physician’s assistants from prescribing any controlled substances.6

Knowing exactly which medical professionals can and cannot 

prescribe opioids in your state will ensure that your program reaches 

the right audience! 

You can find a complete list of mid-level practitioners and their prescribing abilities 

by state here: 

https://www.deadiversion.usdoj.gov/drugreg/practioners/mlp_by_state.pdf
PREPARING FOR PRESCRIBER EDUCATION: GETTING THE LAY OF THE LAND | 3

Q: Who issues prescriber licenses in your state?

Obtaining a federal DEA registration number is just the first step in becoming authorized to 

prescribe controlled substances. All prescribers must also obtain a license from state-designated

licensing boards, which are composed of a combination of practitioners and other community 

members. These licensing boards are responsible for licensing, monitoring, and regulating their 

state’s prescribers. Licenses, and DEA registration numbers, are state specific. Practitioners who 

work across states must obtain multiple DEA numbers and separate state licenses.7

States vary considerably as to where their licensing boards “live.” Some licensing boards are 

housed within their state governments. For example, the Colorado Medical Board sits within the 

state’s Department of Regulatory Agencies. Others exist independently as stand-alone entities, 

such as the Arkansas Medical Board.8

Licensing boards also vary widely in their authority. Some boards have narrow authority over a 

small subset of prescribers; others have broad authority over many different types of 

prescribers. Most have authority over both prescribers who can and cannot prescribe opioids. 

For example, Massachusetts’ Board of Registration in Medicine oversees the licensing for 

physicians, who can prescribe opiates, and acupuncturists, who cannot.9

Knowing who issues licenses to whom, and how these boards are 

organized, will help you focus your educational efforts, identify 

critical gatekeepers, and help you understand the context in which 

the board operates. 

For example, independent prescriber boards may have more flexibility regarding 

prescriber protocols than state-embedded boards, and thus may be more open to 

change. 

For a complete list of prescriber boards by state, visit the Federation of State 

Medical Boards website: http://www.fsmb.org/policy/contacts

The DEA also lists the phone numbers for various licensing boards on 

www.deadiversion.usdoj.gov/drugreg/statebrd.htm
PREPARING FOR PRESCRIBER EDUCATION: GETTING THE LAY OF THE LAND | 4

Q: What educational programming or certifications do prescribers need to obtain 

a license to prescribe opioids?

As part of the Medication Access and Training Expansion Act, practitioners who apply for (or 

renew) their DEA registration after June 2023 are required to complete a one-time, eight-hour 

training on treatment of patients with opioid or other substance use disorders.10 State licensing 

boards have tremendous leeway in determining further educational requirements for 

prescribers seeking a license. States may also require opioid prescriber education as part of their 

continuing medical education to satisfy state licensing requirements.11

State licensing boards also have flexibility in determining their licensure process.

• Some states, like California, use a “one license” process.12

In these states, the DEA 

registration is all that is required to prescribe controlled substances.13

• In other states, like Massachusetts, an additional state-level license is required in 

order to prescribe controlled substances.12

Q: Do opioid prescribers need to adhere to continuing education requirements to 

renew a license?

Many states require continuing education certifications or programming to maintain a prescriber 

license. In some cases, state licensing boards require educational training on specific topics prior 

to license renewal. For example, to reduce racial inequities and disparities within their health 

care systems, several states (including Illinois,14 Massachussetts,15 and Michigan16) have 

implemented mandatory continuing prescriber education on implicit bias. Additional education 

topics may include state and federal requirements for prescribing controlled substances; pain 

management alternatives; appropriate prescribing practices; managing acute pain; palliative 

medicine; prevention, screening, and signs of addiction; responses to prescription drug misuse; 

or end-of-life care.

17

Understanding the certification and educational programming 

required by your state’s licensing boards will prevent you from reinventing the wheel when developing educational programing for 

prescribers, and help you fill any critical education gaps.
PREPARING FOR PRESCRIBER EDUCATION: GETTING THE LAY OF THE LAND | 5

Q: What prescriber education resources are already available?

The federal government has released several prescriber education resources which support best 

practices for safely and appropriately prescribing controlled substances. These resources can

inform or complement prescriber education efforts and include:

• CDC Clinical Practice Guidelines for Prescribing Opioids for Pain. Originally drafted in 

2016 and updated in 2022, these guidelines provide recommendations for prescribers on 

how to determine whether to prescribe opioids for pain, assess for risk factors, and 

address potential harms related to opioid misuse.18

• HHS Pain Management Best Practices. This 2019 report provides a comprehensive look at 

clinical best practices for pain management and recommendations to address gaps in 

care.

19

• HHS Guide for Clinicans on the Appropriate Dosage Reduction or Discontinuation of 

Long-Term Opioid Analgesics. Released in 2019, this report guides prescribers on how to 

determine whether to taper an individual off opioids, and how to do it safely with

integrated behavioral health support.20

Many states, like Maryland21 and Rhode Island,22 have their own educational resources on best 

prescribing practices, which often build upon federal resources.

Understanding your state’s training and continuing education 

requirements will help you align new programming with existing 

efforts, reduce duplication of efforts, and identify content gaps that 

could be met by the prevention sector. 

The Federation of State Medical Boards compiles and updates state-specific 

continuing education requirements annually at: 

http://www.fsmb.org/globalassets/advocacy/key-issues/continuing-medicaleducation-by-state.pdf
PREPARING FOR PRESCRIBER EDUCATION: GETTING THE LAY OF THE LAND | 6

Q: What collaboration opportunities exist to expand or improve prescriber 

education?

Before planning any new prescriber education efforts, conduct an environmental scanato 

identify ongoing state or community efforts. This can minimize duplication of effort and promote 

coordination and collaboration between educational entities.

Whether strengthening existing prescriber education efforts or implementing new ones, seek to

collaborate with medical professionals and associations. They offer a unique understanding of

prescribers’ specific needs and the best opportunities and strategies for providing education.

Potential collaborative partners include:23

• State medical boards

• Trade associations

• Medical schools and teaching hospitals

• Universities

• Hospital systems

• Community health centers

• Policymakers

• Coalitions

• Task forces and working groups

aAn “environmental scan” is a process of systematically identifying existing information (e.g., risk or misuse data, 

resource or capacity data, potential partners, academic literature) that may support accomplishing a preventionrelated goal or initiative.

Identifying existing prescriber education initatives and coordinating 

programming with them can reduce duplication of effort and 

improve service delivery.
PREPARING FOR PRESCRIBER EDUCATION: GETTING THE LAY OF THE LAND | 7

REFERENCES

1 Duff, H. J., Shen, W. W., Rosen, L. W., & Lampe, J. R. (2022). The opioid crisis in the United States: A brief 

history. Congressional Research Service. https://crsreports.congress.gov/product/pdf/IF/IF12260

2 SAMHSA. (2023). Results from the 2022 National Survey on Drug Use and Health: Detailed tables. U.S. 

Department of Health and Human Services.

3 CDC. (2023). Opioid overdose. U.S. Department of Health and Human Services. 

https://www.cdc.gov/drugoverdose/deaths/opioid-overdose.html#

4 Omer, U., Danopoulos, E., Veysey, M., Crampton, P., & Finn, G. (2021). A rapid review of prescribing 

education interventions. Medical Science Educator, 31(1), 273-289. https://doi.org/10.1007/s40670-020-

01131-8

5 Code of Federal Regulations. (n.d.). FDA Registration of Manufacturers, Distributors, and Dispensers of 

Controlled Substances, 21 C.F.R § 1301. https://www.ecfr.gov/cgi-bin/retrieveECFR? 

gp=&SID=ffb071c655915a3939f8e22a96ea0972&mc=true&n=pt21.9.1301&r=PART&ty=HTML 

6 Diversion Control Division. (2022). Mid-level practitioners authorization by state. Drug Enforcement 

Administration, U.S. Department of Justice. 

https://www.deadiversion.usdoj.gov/drugreg/practioners/mlp_by_state.pdf#search%3Dmidlevel%20practitioner 

7 Diversion Control Devision. (n.d.). Registration Q&A. Drug Enforcement Administration, U. S. Department 

of Justice. https://www.deadiversion.usdoj.gov/faq/registration_faq.htm 

8 Federation of State Medical Boards. (n.d.). Contact a state medical board. http://www.fsmb.org/contact-astate-medical-board/ 

9 Executive Office of Health and Human Services. (n.d.). Massachusetts Board of Registration in Medicine 

(BORIM). Commonwealth of Massachusetts. https://www.mass.gov/orgs/board-of-registration-inmedicine 

10 SAMHSA. (2023). Recommendations for curricular elements in substance use disorders training. U.S. 

Department of Health and Human Services. https://www.samhsa.gov/medications-substance-usedisorders/provider-support-services/recommendations-curricular-elements-substance-use-disorderstraining#_edn2 

11 Medical Board of California. (n.d.). Physicians and surgeous continuing medical education. State of 

California. https://www.mbc.ca.gov/Licensing/Physicians-and-Surgeons/Renew/CurrentStatus/Continuing-Medical-Education.aspx 

12 Diversion Control Division. (n.d.). Practitioner’s state license requirements. Drug Enforcement 

Administration, U.S. Department of Justice. https://www.deadiversion.usdoj.gov/drugreg/reg_apps/ 

pract_state_lic_require.htm 
PREPARING FOR PRESCRIBER EDUCATION: GETTING THE LAY OF THE LAND | 8

13 Sullivan, T. (2022, July 17). Illinois to require implicit bias awareness CME training. Policy & Medicine. 

https://www.policymed.com/2022/07/illinois-to-require-implicit-bias-awareness-cme-training.html

14 The University of Vermont. (n.d.). Controlled substances in research guide. 

https://www.uvm.edu/sites/default/files/media/csguide.pdf

15 Board of Registration in Medicine. (2021, November 18). The Massachusetts Board of Registration adopts 

policy requiring CME on the topic of implicit bias in healthcare [Press Release]. Commonwealth of 

Massachusetts. https://www.mass.gov/news/the-massachusetts-board-of-registration-adopts-policyrequiring-cme-on-the-topic-of-implicit-bias-in-healthcare

16 Michigan State Medical Society. (2021). Medical license renewal: What you need to know.

https://www.msms.org/About-MSMS/News-Media/medical-license-renewal-what-you-need-to-know

17 New York State Department of Health. (2022). Frequently asked questions about mandatory prescriber 

education.

https://www.health.ny.gov/professionals/narcotic/mandatory_prescriber_education/docs/faq.pdf 

18 Dowell, D., Ragan, K. R., Jones, C. M., Baldwin, G. T., & Chou, R. (2022). CDC clinical practice guidelines for 

prescribing opioids for pain: United States, 2022. MMWR, 71(RR-3), 1-95. 

https://doi.org/10.15585/mmwr.rr7103a1 

19 Pain Management Best Practices Inter-Agency Task Force. (2019). Pain Management Best Practices InterAgency Task Force report: Updates, gaps, inconsistencies, and recommendations. U.S. Department of 

Health and Human Services. https://www.hhs.gov/sites/default/files/pmtf-final-report-2019-05-23.pdf

20 Working Group on Patient-Centered Reduction or Discontinuation of Long-term Opioid Analgesics. (2019). 

HHS guide for clinicians on the appropriate dosage reduction or discontinuation of long-term opioid 

analgesics. U.S. Department of Health and Human Services. 

https://www.hhs.gov/system/files/Dosage_Reduction_Discontinuation.pdf

21 Maryland Board of Physicians. (n.d.). Board guidance. Maryland Department of Health. 

https://www.mbp.state.md.us/resource_information/res_con/resource_consumer_od_board_guidance.a

spx

22 Rhode Island Department of Health. (n.d.). Safe opioid prescribing. State of Rhode Island. 

https://health.ri.gov/healthcare/medicine/about/safeopioidprescribing/

23 Center for the Application of Prevention Technologies. (n.d.). Opportunities for collaborating with medical 

professionals to prevent opioid misuse. Education Development Center. 

https://solutions.edc.org/sites/default/files/Opportunities-For-Collaborating-With-MedicalProfessionals_508Compliant.pdf

 

SPTAC@edc.org | samhsa.gov/SPTAC