Find questions and answers about prescriptions, pharmacists, poison prevention and other common pharmacy topics.

Why does it take so long to have my prescription filled?
Why should I use just one pharmacy?
Why do prescriptions cost so much?
Is inhalant abuse really a problem?
Why do we need child-resistant caps?
Is iron deadly for young children?
What questions should I ask my pharmacist?
Why do I have to check with my pharmacist before I take an over-the-counter medication?
How can the food I eat affect my medications?
What should I know about my discharge medications?
What is a home care pharmacist?
What affects the cost of medications in a hospital?
What does my hospital pharmacist do?

MPA and Pharmacy – A Review of the 20^th Century

1. Why does it take so long to have my prescription filled?

Your pharmacist does much more than just put pills in a bottle. Your pharmacist checks to see if your new prescription will interact with any of your other medications, causing your harm or discomfort. Your pharmacist also checks to see that the dose and quantity of medication you are receiving is appropriate and even occasionally checks with your doctor to make sure you are getting the best treatment for your condition. These activities all take time, but remember, your pharmacist has your health at heart!

2. Why should I use just one pharmacy?

Your pharmacist cares about your health and wants to make sure you use all of your medications properly. To effectively look after your health, your pharmacist must have access to all of your medication records, including over-the-counter purchases. In this way, your pharmacist can monitor your medication usage, watch for potential drug interactions, intercept possible drug allergies, and aid you in the proper selection of over-the-counter medicines. Your pharmacist can save you from potentially harmful medication problems, but only if he has all of the necessary information on hand. So, choose your pharmacy and your pharmacist carefully and then let them take care of all your medication needs.

Glad you asked!

3. Why do prescriptions cost so much?

The medicines available today are the result of a tremendous amount of research, testing and development. Drug manufacturers investigate thousands of potential drug products each year, and approximately only one out of 4000 drug products come to the market place for patient use. All of these drug products are thoroughly investigated for use until something occurs which makes the product unfit for human use. The above process can take well over ten years. Because potential drugs have to be patented at the beginning of testing, drug manufacturers have only a short period of time in which they can recover the cost of investigation and development. After their patents expire, other manufacturers can produce and sell the products without having to pay for the investigation and research costs.

Glad you asked!

 

4. Is inhalant abuse really a problem?

Yes. In 1991-92, nearly one in ten of the Michigan eighth graders surveyed reported current inhalant use within the past 30 days. These youths are inhaling substances such as gasoline, nail polish remover, air freshener, spray paint and correction fluid in order to get high. Not only are these items highly toxic to many of the human body’s vital organs, but they can cause instant death.

Use of these highly accessible products by our youth creates the drug dependent personality that may eventually lead to abuse of other highly addictive narcotic substances.

5. Why do we need child-resistant caps?

Although labeling requirements and educational programs have had some effect in decreasing the frequency of poisonings, significant numbers of children are still being poisoned by ingesting household products that can be hazardous, such as medicines (sometimes brought into the child’s home by grandparents), cleaning products, and solvents. Child-resistant packaging, if used properly, provides an additional barrier to help prevent accidental ingestion.

Ask for and use household substances that are available in child-resistant packaging. Insist on safety packaging for prescription medicines. Have the number of your local poison center and physician near the telephone at all times.

6. Is iron deadly for young children?

Yes. According to poison control center data, iron supplements are responsible for 30 percent of poisoning deaths from medications in young children. Iron is available in combination with vitamins or alone. A small amount of iron pills consumed by a child can cause death. Poisonings happen when children swallow their parents’ iron pills.

The U.S. Consumer Products Safety Commission requires that iron-containing medicines and vitamins with iron be packaged in child-resistant closures. All medicines, especially those with iron, should be kept out of the reach of children. Have the number of your local poison center and physician near the telephone at all times.

7. What questions should I ask my pharmacist?

Your pharmacist wants you to use your medications properly, but, in order for you to do so, you must know the basics. You can learn a lot about your medication by asking a few simple questions, such as the following:

• What is the name of my medication?
• What is the medication used for?
• When should I take my medication?
• Are there any special instructions on how to use my medication?
• What are some of the common side effects of my medication, and how should I handle them?
• Are there any interactions,with my other medications or some over-the-counter medicines, of which I should be aware?

8. Why do I have to check with my pharmacist before I take an over-the-counter medication?

Medicines you buy without a prescription are usually safe and effective and can be used to treat minor ailments. However, over-the-counter medications CAN interact with any other medicines you are taking and can even make some conditions you have worse. For example, decongestants commonly used to treat colds and sinus allergies may aggravate high blood pressure. Always check with your pharmacist before purchasing and using any over-the-counter medication to make sure it won’t cause you any harm.

9. How can the food I eat affect my medications?

When taking some medications, you may need to keep away from certain foods in your diet to avoid potentially serious food/drug interactions.

Different foods can increase, decrease or delay a drug's action. Grapefruit juice, for example, can increase the level of some medications in the blood, making the medications seem too strong for a person. Likewise, some people are at a higher risk for food/drug interactions. If you are age 65 or older, are pregnant or nursing, have a restricted diet or drink alcohol, you can be at a higher risk for food/drug interactions.

Be sure to ask your pharmacist about food/drug interactions for your medications. 

Glad You Asked!

10. What should I know about my discharge medications?

Your pharmacist wants you to use your medications properly, but in order for you to do so, you must know the basics. You can learn a lot about your medication by asking a few simple questions, such as the following:

• What is the name of my medication?

• What is the medication used for?

• When should I take my medication?

• Are there any special instructions on how to use my medication?

• What are some of the common side effects of my medication and how should I handle them?

• Are there any interactions, either with my other medications or some over-the-counter medications that I should be aware of?

• How long should I take this medication?

Glad You Asked! 

11. What is a home care pharmacist?

Home care pharmacists specialize in caring for people who are receiving complex drug therapies in the home setting. This type of care includes care for people who are receiving intravenous (I.V.) medications such as antibiotics, pain relievers or certain heart medications, or I.V. nutrition for people who cannot eat.

A home care pharmacist works closely with home nurses and physicians to help patients and families learn to manage this care at home. The pharmacist often recommends which medication to use and plays a very important part in monitoring the patient's response to the therapy. The pharmacist often communicates with the patient or family by regular telephone contact. Sometimes, the pharmacist may even make a home visit.

Glad You Asked!

12. What affects the cost of medications in a hospital?

Two primary costs are associated with your hospital medications. First is the cost paid by the pharmacy for your medication. Second are the costs for the people who handle your medication order.

Pharmacists, for example, calculate and check medications for accuracy. Technicians prepare medications using special equipment. Computers are used to list all your hospital medications, and pharmacists use this list to check for allergy and drug interaction warnings.

Together, these resources require money. Part of the money comes from the cost assigned to your hospital medication.

Glad You Asked!

13. What does my hospital pharmacist do?

Your pharmacist is always working on ways to improve your care in the hospital.

All of your medication orders are reviewed by a pharmacist to ensure safe and effective therapy. The medication dose, frequency and administration and your allergy history are assessed, as well as problems that may result from interactions with your other medications.

The pharmacist serves as a drug information resource for physicians, other healthcare professionals, and you!

Pharmacists play an important role on many hospital committees to develop the best medication protocols and programs to serve you and your needs.

Pharmacists use their specialized knowledge to help manage your medication therapy in and outside of the hospital.

Glad You Asked!

Larry Wagenknecht, MPA Chief Executive Officer

On the dawn of 2000, it is appropriate to look back at the last 100 years. Michigan pharmacy has a strong and rich heritage of which every person associated with pharmacy should be very proud. The Michigan Pharmacists Association is currently one of the premier pharmacy associations in the country. Its success and leadership within the profession has not occurred by accident or by chance. The success of the organization can be tied directly to the leadership of many Michigan pharmacists who were able to use their insights to direct the profession.

While most people are tired of hearing about the new millennium and the arguments that have occurred over when the "new" millennium begins, I have attempted to capture some of the pharmacy highlights that have occurred over the last 100 years. Fortunately (for me) MPA published a very detailed history of pharmacy in Michigan back in 1983 as part of MPA’s celebration of its 100^th anniversary. A great deal of information within this article (for the years of 1883-1983) is attributed the excellent compilation of Michigan’s unique history by Michael C. Shannon of Ann Arbor in collaboration with Cynthia Beeber of Lansing.

The heritage of pharmacy in Michigan begins much earlier than 1900. The association’s activities go back to 1883. It was recorded that on November 14, 1883, in the Chamber of the Michigan House of Representatives, 77 Michigan pharmacists gathered to create the Michigan State Pharmaceutical Association (MSPA). The major objectives of the association were to elevate the profession and advance the legitimate interest of the drug trade. Shortly after the creation of the association on June 2, 1885, Michigan’s first Pharmacy Act was approved by the state legislature, where it remained basically unchanged until 1921. On June 12, 1885, the first Board of Pharmacy was appointed by Gov. Russell Alger. Throughout this article there are several references to the national associations. The American Pharmaceutical (now Pharmacists) Association was founded in 1852 and in 1882 the National Association of Retail Druggists (NARD) was founded.

Undoubtedly, several significant events in pharmacy have been missed. It is impossible to list within this article every event. As you review the events, please make note of your thoughts and please direct them to the MPA office. Since 1983 there has not been a "history of Michigan pharmacy" article published.Thank you in advance for your assistance and best wishes for the new year!

1900s

1900 – There were three formal educational opportunities for aspiring pharmacists in Michigan – Detroit Institute of Technology, Ferris Institute and the University of Michigan.

1900 – The American Conference on Pharmaceutical Faculties was founded as part of APhA’s Section on Education and Legislation. It eventually became the American Association of Colleges of Pharmacy.

1901 – Michigan passed an Itinerant Vendors Act requiring the traveling vendors of drugs to get a license.

1902 – MSPA had 230 members, a decline from a high of 971 members in 1888.

1903 – The first license to manufacture biologicals in the U.S. was granted to Parke-Davis & Co. in Detroit.

1905 – Minor law changes requiring for licensing were increased to a 10^th grade education, 18 years of age and two years of practical experience.

1904 – National Association of Boards of Pharmacy was founded. Its primary concern was reciprocity between Michigan and the other states.

1906 – The passage of the first Food and Drug Act referred to as one of the "most tumultuous times" in pharmacy’s history in the United States. It was primarily a "truth in labeling" law and was to begin the process of eliminating secret formulas from the marketplace.

1907 – Professor W. H. Allen persuaded the Detroit Technical Institute to take over the administration of pharmacy classes. This eventually became the School of Pharmacy at the Detroit Institute of Technology, which later merged with Wayne State’s School of Pharmacy.

1907 – The member schools of the American Association of Colleges of Pharmacy adopted a two-year curriculum as the minimum for completing a pharmacy degree program.

1908 – The American Pharmaceutical Manufacturers Association was established. It was the forerunner of the Pharmaceutical Manufacturers Association, which later changed its name to the Pharmaceutical Research and Manufacturers of America.

1910s

1912 – The Michigan Retail Druggists Association, founded in 1910, merged with the Michigan State Pharmaceutical Association.

1913 – MSPA had 717 members.

1913 – Michigan had 3,585 pharmacists and 407 registered druggists (assistants).

1918 – Michigan passed a statewide prohibition law, one year before the national prohibition law was passed.

1918 – MSPA had 849 members.

1919 – A major revision of the Pharmacy Act occurred, requiring (1) pharmacists to have a 10^th grade education, (2) apprentices must register with the Board, (3) one week of experience was defined as 48 hours.

1919 – Oral digitalis tablet became Upjohn’s first major research-based development.

1920s

1921 – Individual drug stores were required to be licensed.

1923 – MSPA had 1,081 members.

1923 – There were 2,491 pharmacies licensed by the state.

1924 – A change in the Pharmacy Act required pharmacists to have a 12^th grade education.

1924 – Detroit’s second college of pharmacy, Detroit’s City College, grew out of the vocational subject credit offerings at Cass Technical High School. It later became a unit of Wayne State University.

1924 – Cheracol was introduced by Upjohn.

1925 – The Pharmacy Act was strengthened by requiring pharmacists to be 21 years old, have a 12^th grade education, have two years of experience, take the licensing examination, and complete two years in an accredited pharmacy school. The act went into go into effect in 1929. Assistant pharmacists had to be 18 years old, have a 10^th grade education, have two years of experience and pass an exam.

1925 – The National Association of Boards of Pharmacy began to require graduation from an accredited pharmacy school as a prerequisite for licensure. Prior to this time, apprenticeship continued to be the most popular form of pharmacy training.

1927 – The pharmacy ownership law passed requiring that at least 25 percent of the stock of a pharmacy be owned by a registered pharmacist. The law included a grandfather clause for pharmacies already licensed before the effective date of the law.

1927 – Harvey A. K. Whitney started his first hospital pharmacy internship at the University of Michigan hospitals.

1930s

1931 – The Pharmacy Act changed to allow the state to issue certificates only to registered pharmacists, not assistants.

1931 – The Thermometer Act passed, regulating the manufacture and labeling of thermometers to ensure reliable instruments for measuring temperature.

1931 – Twelve percent of the total number of pharmacies in Detroit were chain pharmacies with more than four units (123 of 1,016 pharmacies).

1932 – Michigan’s prohibition was repealed.

1932 – The American Council on Pharmaceutical Education (ACPE) was founded.

1933 – The College of Pharmacy of Detroit’s City College became a part of Wayne State University.

1933 – Each of the four colleges of pharmacy in Michigan offered or were soon to offer the four-year bachelor’s of science curriculum.

1933 – The National Association of Chain Drugstores was founded.

1933 – MSPA established its House of Delegates.

1935 – The Pharmacy Act was changed to require a four-year bachelor’s degree from an accredited school of pharmacy, with a 1938 effective date.

1935 – Sulfa drugs were discovered.

1937 – Michigan passed the Uniform Narcotic Act, bringing the state into alignment with other states and federal law.

1938 – The Food, Drug and Cosmetic Act was passed by Congress to require that new drugs be tested for "safety" prior to marketing. Congress initiated the Act after at least 70 deaths in 1937 resulting when di-ethylene glycol was used as the elixir base for sulfanilamide.

1939 – The American College of Apothecaries was founded as the Conference of Professional Pharmacists. The original name lasted for only one year.

1940s

1941 – The state passes prophylactic sale law, limiting the sale of prophylactics to pharmacies.

1942 – The American Society of Hospital Pharmacists was formed.

1943 – The Pharmacy Act was modified to eliminate the apprenticeship system, and the Dangerous Drug Act was passed, making barbituric acid and its derivatives, chloral hydrate and paraldehyde, subject to prescription order dispensing.

1943 – MSPA had 910 members and there were 2,000 pharmacies licensed by the Board of Pharmacy.

1944 – Full-scale penicillin production was achieved by a consortium of American drug manufacturers funded by the U.S. government and assisted by British scientists.

1944 – Streptomycin was discovered.

1948 – MSPA had 1,131 members.

1948 – Chloramphenicol was discovered.

1949 – The Pharmacy Act was changed to require that one member of the Board of Pharmacy be from the Upper Peninsula.

1949 – Neomycin is discovered.

 1950s

1950 – Fire destroyed the pharmacy department’s quarters and library at Ferris Institute.

1950 – Ferris Institute became Ferris State College under new state legislation.

1952 – The Durham Humphrey Amendments to the Food, Drug and Cosmetic Act separated pharmaceuticals into prescription and non-prescription medications.

1952 – Erythromycin was isolated.

1952 – Cortisol was marketed.

1952 – Chlorpromazine was tested.

1953 – The Pharmacy Act was modified to require one year of practical experience in a board-approved site under the direction of a registered pharmacist with six months of that experience being completed after graduation and required that licensees had to provide an affidavit of their qualifications (effective in 1955).

1953 – There were 2,866 pharmacies licensed by the Board of Pharmacy.

1954 – The Pharmacy Act was modified to require that each place of business (where pharmacy was practiced) to have an individual license, valid for one year.

1956 – A new pharmacy building was erected at Ferris State College.

1959 – The Pharmacy Act was modified to require 2,000 hours of internship prior to licensure.

1960s

1960 – ACPE and the colleges of pharmacy adopted the five-year curriculum with the first graduates appearing in 1965.

1960 – The University of Michigan provided the first optional six-year Pharm.D. degree.

1962 – There were 1,300 MSPA members.

1962 – MSPA bylaws were approved that provided for the unification of pharmacy from national to the local level. They included affiliation with APhA and allowed employee pharmacists to join the association as full-fledged members with all privileges.

1962 – Local associations became affiliated with MSPA.

1962 – The original 1885 Pharmacy Act was completely replaced by a new Pharmacy Act. The new Pharmacy Act redefined the practice of pharmacy, strengthened control of drug distribution, listed rules of conduct for practitioners and strengthened licensure requirements.

1962 – Board of Pharmacy Administrative Rule 16 was adopted which governed the distribution of drugs within hospitals. It was the first legal authority for such control in the United States.

1963 – The House of Delegates was re-established as the policy-making body of the MSPA.

1963 – MSPA published The Michigan Pharmacist as its official journal.

1963 – 2,780 pharmacies were licensed by the Board of Pharmacy.

1965 – Congress passes legislation that created Medicaid and Medicare.

1965 – MSPA began providing pharmacist continuing education programs statewide.

1965 – MSPA establishes the Employer-Employee Relations Commission.

1967 – Michigan Medicaid implemented its first fee-for-service prescription program, paying pharmacists the cost of the drug plus a $2 dispensing fee.

1967 – The National Association of Boards of Pharmacy (NABP) initiated national pharmacy exam to be offered to all of the states.

1968 – NABP started its "Blue Ribbon Examinations" for pharmacy licensure as a step toward a standardized license examination.

1968 – MSPA founded the Michigan Pharmaceutical Service Corporation and entered into a third party prescription prepayment program with the City of Detroit and the Detroit Maternity and Infant Care program.

1968 – The Michigan Apothecaries Political Action Committee (MA-PAC) was established.

1969 – On October 1, the United Auto Workers’ contract provision for prescription coverage was implemented.

1969 – The Pharmacy Act were modified to decrease the minimum age that a person could be licensed from 21 to 18 years of age.

1969 – MSPA and APhA defended their Code of Ethics in court.

1969 – There are 2,211 pharmacies licensed by the Board of Pharmacy – 1,673 community, 220 chain, and 318 hospital pharmacies.

1970s

1970 – Congress passes the Comprehensive Drug Abuse Prevention and Control Act and the Controlled Substances Act.

1970 – Michigan law was amended to require pharmacist representation on the Blue Cross Blue Shield Board of Directors.

1970 – MSPA adopts a revised Code of Ethics.

1970 – There were 2,826 MSPA members.

1971 – Michigan adopts its own Controlled Substances Act as a part of the Public Health Code.

1972 – The American Society of Hospital Pharmacists breaks away from APhA as an independent professional association.

1973 – MSPA adopted its new name, the Michigan Pharmacists Association.

1973 – There were 2,927 members.

1973 – There were 2,273 pharmacies licensed by the Board of Pharmacy – 1,522 community, 439 chain, and 312 hospital pharmacies.

1973 – The Drug Enforcement Agency (DEA) was set up to coordinate enforcement efforts.

1973 – Michigan adopted the Physician’s Assistant Act within the Public Health Code.

1974 – Michigan was the first state to provide pharmacists the authority to substitute generic medications without contacting the prescriber, through the enactment of the Drug Product Selection legislation.

1974 – Michigan increased the Board of Pharmacy to seven members with one to be a lay member.

1974 – MA-PAC became Pharmacy PAC.

1975 – The College of Pharmacy at Wayne State University was merged into the new College of Pharmacy and Allied Health Professions.

1976 – The NABPLEX™ standardized examination was administered for the first time.

1976 – MPA adopted a Code of Ethics.

1977 – MPA moved into its current headquarters in Lansing.

1978 – MPA supported passage of the new Public Health Code that became effective on September 30, 1978.

1978 – There were approximately 3,200 MPA members.

1978 – There were 2,169 pharmacies licensed by the Board of Pharmacy – 1,369 community, 510 chain and 290 hospital pharmacies.

1978 – The NABPLEX™ examination is administered only on uniform dates to enhance stability.

1978 – Michigan Pharmacy Technician Forum is established.

1979 – The University of Michigan admited its first class of six-year Pharm.D. students as its only entry level degree offered.

1979 – MPA established the Ethics & Practice Commission.

1979 – Michigan Society of Hospital Pharmacists was established as a practice section of the MPA.

1979 – Michigan Staff Chain Pharmacists Section was established as a practice section of the MPA.

1979 – Component Organizations were recognized within MPA.

1980s

1981 – PSI (Pharmacy Services Inc.) was created as a wholly owned, for-profit subsidiary by MPA to assist community pharmacists in increasing the profitability of their pharmacies.

1981 – Pharmacy Technician Certification and Accreditation Program was established by MPA, creating Pharmacy Certified Technicians.

1982 – Pharmacy Technician Forum was changed to the Michigan Society of Pharmacy Technicians.

1982 – Parke Davis phased out its Detroit manufacturing efforts.

1983 – New bylaws, consistent with the Model Bylaws, were adopted by all local associations.

1983 – PSI established PSI Limited Insurance to provide workers’ comp insurance to pharmacy owners.

1984 – Pharmacy NETWORK, a pharmacy services administrative organization that administers pharmacy claims for clients, was launched as a subsidiary of PSI.

1984 – Michigan Staff Pharmacists Section was established as a practice section of the MPA.

1985 – PSI’s subsidiary, Pharmacy Systems, an online pharmacy claims processing system and software vendor, was launched.

1986 – There are 8,570 licensed pharmacists in Michigan.

1986 – The Michigan Pharmaceutical Representatives Section was established as a practice section of the MPA.

1986 – The Michigan Employee Pharmacists Section was established as a practice section of the MPA.

1987 – Ferris State College becomes Ferris State University.

1987 – Congress adopted the Prescription Drug Marketing Act, establishing requirements for manufacturers in the distribution of samples and eliminating diversion occurring within pharmacy wholesalers.

1988 – The Triplicate Prescription Program was adopted by the Michigan Legislature to control the diversion of C-II controlled substances.

1989 – There were 9,029 licensed pharmacists in the state.

1990s

1990 – MPA was successful in having physician dispensing legislation signed into law that limited to whom a physician could delegate the dispensing of medications and required the physician to abide with all of the labeling and record keeping requirements required of pharmacists.

1990 – OBRA-’90 is adopted by Congress which requires that pharmacists "offer to counsel." Medicaid patients and mandates that state Medicaid programs receive "best pricing" through rebates.

1994 – Michigan amended the Public Health Code to recognize substance abuse as a disease and creates the Health Professional Recovery Committee to establish guidelines and to assist health professionals with substance abuse and mental illness. The composition of the Board of Pharmacy was changed to consist of six pharmacists and five public members.

1995 – MPA, the Michigan State Medical Society, the Michigan Osteopathic Association, the Michigan Nurses Association and the Michigan Psychological Association created the Michigan Health Professional Recovery Corporation to bid on the state contract to monitor health professionals with substance abuse and mental illness problems.

1995 – MPA’s Pharmacy Certified Technician program merged with the Illinois Council of Hospital Pharmacists, APhA and ASHP to create the Pharmacy Technician Certification Board.

1995 – MPA adopted its current bylaws.

1995 – Michigan Pharmaceutical Representative Section became the Michigan Pharmaceutical Representatives Society and becomes an MPA Affiliated Chapter.

1995 – Public Health Code is amended to change the Triplicate Prescription Program into the "Official Prescription Program."

1995 – After numerous years of efforts, Medicaid reimbursement changed from Actual Acquisition Cost to Estimated Acquisition Cost.

1995 – The Board of Pharmacy repealed the Interpretive Statement on Supportive Personnel. The Interpretive Statement included technician ratios and specific tasks that could not be delegated to pharmacy technicians.

1996 – Delegates from the four Michigan regional health-system societies were seated in the MPA House of Delegates.

1996 – The Michigan Health Professional Recovery Corporation received the contract from the State of Michigan to monitor recovering health professionals.

1997 – ACPE adopted the six-year Pharm.D. degree as the entry level degree for pharmacists, to be implemented by 2001.

1997 – The Michigan Society of Hospital Pharmacists changed its name to the Michigan Society of Health-System Pharmacists.

1998 – There were 2,315 pharmacies licensed by the Board of Pharmacy – 718 independents, 1,145 chain, 111 home infusion/long term care and 285 hospital pharmacies.

1998 – There were 11,466 Michigan licensed pharmacists – 7,788 residing within the state.

1998 – The Board of Pharmacy adopted a new Administrative Rule 20 which requires pharmacists to counsel patients on new medications and clarified the responsibility to the pharmacist on delegated tasks.

1998 – The Board of Pharmacy implemented computer adaptive testing for the NAPLEX™ licensure exam allowing pharmacy graduates to take the exam at numerous locations and over a several week period.

1999 – There were 3,750 MPA members.

1999 – Physician assistants and nurse practitioners obtained delegated authority to prescribe controlled substances.

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