Most pharmacists were trained around a familiar division of responsibility.
The prescriber writes the prescription.
The pharmacist evaluates it, dispenses it, counsels the patient, identifies problems, and recommends changes when needed.
But that line is not fixed everywhere.
A September 18 Pharmacy Times feature highlighted pharmacists practicing in chronic pain, palliative care, and substance-use-disorder settings who have obtained DEA registrations and are prescribing controlled substances within the authority granted to them by their state, scope of practice, collaborative arrangements, and practice environment.
One pharmacist described working in a chronic pain clinic where obtaining DEA registration allowed her to initiate Schedule III through V medications, particularly buprenorphine products, rather than making a recommendation and waiting for another prescriber to enter the order.
Another described a palliative-care service where pharmacists could make controlled-substance adjustments under an established consult agreement. After pharmacist controlled-substance prescribing was implemented, the team’s internal quality analysis found that average turnaround time from a symptom-related phone call to a signed controlled-substance prescription decreased from 178 minutes to 101 minutes.
A third pharmacist described using controlled-substance prescribing authority in pain and substance-use-disorder care to support opioid tapering, initiate buprenorphine, and provide closer follow-up.
That does not mean every pharmacist can apply for a DEA number tomorrow and start prescribing controlled substances.
But it should change the way pharmacists think about the potential ceiling of the profession.
The DEA registration is not what creates the authority
This distinction is essential.
DEA registration does not independently give a pharmacist the legal right to prescribe controlled substances.
The DEA itself states that an individual practitioner registration is based on underlying state authority. State licensing boards determine whether a practitioner is permitted to prescribe, administer, or dispense controlled substances and which schedules that practitioner may handle. A federal DEA registration cannot create prescribing authority that the practitioner does not already have under the applicable law and professional scope.
For pharmacists, that means the answer depends heavily on where and how they practice.
State law matters.
Scope of practice matters.
Collaborative practice authority may matter.
Institutional privileges may matter.
The specific controlled-substance schedules permitted may matter.
The practice environment may matter.
Additional state requirements around prescription drug monitoring programs, urine drug testing, naloxone, treatment agreements, supervision, or documentation may matter.
And then DEA eligibility and registration sit on top of that structure.
That complexity is actually what makes this topic so important.
There is no single national pharmacist scope of practice.
The pharmacist job most people are familiar with is only one version of what a pharmacist may legally be allowed to do.
Some pharmacists are already practicing much further down the continuum
When pharmacists talk about scope expansion, the conversation often follows a predictable sequence.
First came vaccinations.
Then testing.
Then limited prescribing for certain conditions.
Then collaborative practice agreements.
But the examples highlighted by Pharmacy Times show that some pharmacists are operating considerably further along that continuum.
In the chronic pain example, Jessica Geiger, PharmD, described working within an interdisciplinary Veterans Affairs pain clinic. Before obtaining DEA registration, she could initiate and adjust noncontrolled medications but had to send controlled-substance recommendations to another authorized prescriber.
Once she obtained the appropriate registration and was working within her permitted scope, she could prescribe certain Schedule III through V therapies herself, including buprenorphine products. She described that as reducing delays during medication transitions and allowing her to take more direct responsibility for medication management.
In palliative care, Tristan Tyger, PharmD, described pharmacists helping manage symptoms for patients already established with an interdisciplinary oncology palliative-care team.
When patients called between visits with changing symptoms, nurses could triage the issue and route medication-related concerns to pharmacists. Under the team’s consult structure, pharmacists were already able to make certain medication adjustments. DEA registration expanded that workflow to controlled substances within their permitted authority, allowing the pharmacist to implement changes without waiting for another provider to sign the prescription.
These are not theoretical legislative proposals.
These pharmacists are describing workflows happening in actual practice environments.
And that should expand how students and practicing pharmacists think about the profession.
Buprenorphine makes the shift especially interesting
Substance-use-disorder care is one area where this expanded authority could have significant implications.
Federal law changed substantially in 2022 when Congress eliminated the former DATA Waiver, commonly called the X-waiver, requirement for prescribing buprenorphine for opioid use disorder.
DEA guidance now states that a qualified practitioner may prescribe buprenorphine for opioid use disorder using a standard DEA registration, assuming the practitioner’s state law and professional authority allow it. The federal X-waiver itself is no longer required.
That last part is critical for pharmacists.
The federal barrier may have changed, but pharmacists still need the underlying legal authority to prescribe.
A PharmD degree alone is not enough.
Yet in places where pharmacists have that authority, the combination of state scope expansion and federal changes around buprenorphine creates a very different practice possibility than many pharmacists were shown in school.
A pharmacist may not simply be counseling someone about buprenorphine.
In the right legal and practice structure, the pharmacist may be helping initiate and manage it.
That is a very different level of responsibility.
State law is moving faster than many pharmacists realize
This is not happening uniformly.
In fact, the patchwork itself has created regulatory friction.
In March 2025, ASHP joined multiple national pharmacy organizations in asking DEA to update its registration process and state authorization information to reflect newer state laws granting pharmacists controlled-substance prescribing authority.
The organizations specifically pointed to states where pharmacist authority had expanded but federal registration systems had not fully caught up with those changes.
That tells us something important about scope expansion.
Sometimes the profession changes before the average pharmacist notices.
A legislature changes a law.
A board updates regulations.
A health system creates a new collaborative practice structure.
An institution grants privileges.
A federal barrier changes.
A new care model becomes possible.
Meanwhile, thousands of pharmacists continue searching job boards based on the version of pharmacy practice they already know.
That is the opportunity I want Pharmacy Unlocked readers to see.
Your current job description is not the same thing as your professional ceiling
This is the bigger lesson.
Imagine two pharmacists licensed in the same profession.
One spends nearly the entire day verifying prescriptions and solving operational problems inside a traditional dispensing workflow.
Another works in chronic pain, modifies therapy under an advanced scope, monitors controlled-substance treatment, manages complex opioid regimens, and carries their own DEA registration.
Both are pharmacists.
The difference is not the degree.
The difference is what the legal environment, training, practice model, collaborative structure, institutional support, and individual role allow that pharmacist to do.
That distinction applies far beyond controlled substances.
A pharmacist’s current job tells you what that organization hired that pharmacist to do.
It does not necessarily tell you everything a pharmacist could legally, professionally, or operationally do somewhere else.
That is a mindset shift worth making early in your career.
If your only reference point for pharmacy practice is the job you have personally worked, the profession can look much smaller than it actually is.
This changes how pharmacists should search for careers
If you type only “pharmacist” into a job board, you will mostly see the roles employers have chosen to label pharmacist.
That is useful, but incomplete.
Start searching the care environments where medication authority and medication management are central.
Try:
Substance use disorder
Pain management
Palliative medicine
Ambulatory care
Psychiatry
Collaborative practice
Pharmacist prescriber
Medication management
Then look at the job descriptions.
What authority does the pharmacist actually have?
Can they initiate therapy?
Can they modify doses?
Can they discontinue medications?
Can they order laboratory tests?
Can they manage protocols?
Can they prescribe?
Can they handle controlled substances?
What oversight structure exists?
What credentials are required?
You begin seeing a different profession.
Not because every pharmacist should pursue the most expansive scope possible.
But because you cannot make an informed career decision if you do not know the options exist.
The interesting part is not the DEA number
It would be easy to turn this into:
“Pharmacists can prescribe controlled substances now.”
That would be inaccurate.
Authority remains highly variable, and pharmacists should verify current requirements directly with their board of pharmacy, applicable statutes and regulations, employer, and DEA before assuming they qualify. Even DEA’s own controlled-substance authority table is organized state by state because the underlying authority is not uniform.
The better takeaway is this:
Scope is becoming a career variable.
Where you practice can change what you are allowed to do.
The organization you join can change how much of that authority you actually use.
The specialty you enter can change how deeply you participate in medication decisions.
The collaborative structure can change whether you recommend a therapy or implement it.
Your training can change the level of responsibility an organization is willing to give you.
That means pharmacists should evaluate jobs not only by salary, location, schedule, and title.
Ask:
What am I actually allowed to do here?
That question could matter just as much.
Greater authority also means greater responsibility
There is another side to this that should not be ignored.
Expanded scope is not simply about pharmacists gaining permission to prescribe more medications.
With greater authority comes responsibility for the decisions being made.
Controlled-substance prescribing can involve complex clinical, legal, ethical, and safety considerations.
DEA registration also comes with federal requirements. For example, since June 2023, new and renewing DEA-registered practitioners, other than veterinarians, generally must satisfy the one-time eight-hour training requirement related to the treatment and management of patients with opioid or other substance-use disorders.
State requirements can add additional layers.
The Pharmacy Times authors specifically highlighted potential obligations involving prescription drug monitoring, urine drug testing, naloxone prescribing, controlled-substance agreements, and other safeguards depending on the jurisdiction and practice setting.
That is exactly how expanded pharmacy practice should evolve.
More authority should come with the systems, training, accountability, and clinical infrastructure required to use it safely.
The goal is not simply more prescribing.
The goal is better medication care.
The healthcare system may also need pharmacists to use more of their training
The pharmacists interviewed in the September feature repeatedly described the same practical problem.
They could evaluate the patient.
They could identify the medication change.
They could make the recommendation.
But when another prescriber had to separately review and enter the controlled-substance order, care slowed down.
In palliative care, that meant longer turnaround for symptom management.
In chronic pain, it could mean delays during opioid transitions.
In substance-use-disorder care, it could interrupt continuity at a time when close follow-up matters.
That does not mean pharmacist prescribing is appropriate in every setting.
It does illustrate why healthcare systems explore it.
If a pharmacist already possesses the medication expertise, has an established patient-care role, works within an appropriate scope, and is integrated into the clinical team, there may be situations where requiring an additional prescriber solely to execute the pharmacist’s medication plan adds delay without adding proportional value.
That is ultimately what scope expansion should be evaluated against.
Does it improve access?
Does it improve safety?
Does it reduce unnecessary friction?
Does it allow each member of the care team to contribute at the highest level their training and legal authority support?
Those are better questions than arguing about titles.
Your Pharmacy Unlocked challenge this week
Do one thing.
Look up your own state’s current pharmacist scope and prescribing authorities.
Do not rely on what you were told in pharmacy school.
Do not rely on what your current employer allows.
Do not rely on what another pharmacist remembers from five years ago.
Go to your state board of pharmacy and the current statutes or regulations.
Then answer this question:
What can pharmacists legally do in my state that my current job does not allow me to do?
Maybe the answer involves collaborative drug therapy management.
Maybe pharmacists can prescribe for certain conditions.
Maybe they can order laboratory tests.
Maybe they can furnish specific medications.
Maybe they can participate in protocols you did not know existed.
Maybe controlled-substance authority exists in a narrow practice environment.
Maybe the answer is that your state remains much more restrictive.
All of those answers are useful.
Because the gap between:
what pharmacists are legally capable of doing
and
what your current position asks you to do
may contain a career opportunity.
Then go one step further.
Search for organizations actually using that authority.
Which health systems?
Which clinics?
Which specialties?
Which ambulatory programs?
Which behavioral-health organizations?
Which academic centers?
Scope on paper only becomes a career when someone builds a practice model around it.
Do not confuse the most common version of pharmacy with the only version
Most pharmacists will never need DEA registration.
Many will never want prescribing authority for controlled substances.
That is not the point.
The point is that examples like these force us to reconsider how we define the profession.
There are pharmacists practicing in environments where they are not simply recommending medication changes.
They are implementing them.
There are pharmacists managing complex controlled-substance therapies.
There are pharmacists working in pain, palliative care, and substance-use-disorder treatment with authority many students may never have realized a pharmacist could hold.
That does not mean the profession has reached some final expanded scope.
It means the ceiling is not the same everywhere.
And it is probably higher than many pharmacists think.
So the next time you look at your job description and wonder whether this is all a PharmD can lead to, separate two questions.
What does my current job allow me to do?
and
What is the profession capable of allowing me to do?
Those answers can be very different.
And somewhere inside that difference may be the next version of your career.
Resources & Citations
1. Tyger T, Boyer J, Geiger J. “Bridging the Gap: Pharmacist Experiences Obtaining DEA Licenses.” Pharmacy Times. September 18, 2026.
Primary source for the pharmacist practice examples discussed in this article, including chronic pain, palliative care, and substance-use-disorder settings; Schedule III through V prescribing; buprenorphine use; collaborative and consult arrangements; workflow improvements; and barriers surrounding pharmacist DEA registration. The article also emphasizes state-by-state variation and recommends pharmacists verify requirements with their state board of pharmacy.
Read the Pharmacy Times feature
2. U.S. Drug Enforcement Administration, Diversion Control Division. “Registration Q&A.”
Official DEA guidance explaining that an individual practitioner DEA registration is based on underlying state authority and does not independently authorize a practitioner to prescribe controlled substances outside the privileges granted by the relevant state.
DEA Registration Q&A
3. U.S. Drug Enforcement Administration, Diversion Control Division. “Mid-Level Practitioners Authorization by State.”
DEA resource describing controlled-substance authority by practitioner type and state, including registered pharmacists where applicable. The resource illustrates why pharmacist controlled-substance authority must be evaluated by jurisdiction and specific schedule or activity.
DEA state authorization resource
4. U.S. Drug Enforcement Administration, Diversion Control Division. “Buprenorphine (MOUD) Q&A.”
Official DEA guidance confirming that Congress eliminated the DATA Waiver, or X-waiver, requirement in 2022 and that appropriately authorized DEA registrants no longer need a separate waiver number to prescribe buprenorphine for opioid use disorder. State scope and other applicable requirements still apply.
DEA buprenorphine guidance
5. U.S. Drug Enforcement Administration, Diversion Control Division. “Medication Assisted Treatment.”
Official DEA guidance describing the one-time eight-hour substance-use-disorder training requirement that generally applies to new and renewing DEA-registered practitioners, other than veterinarians.
DEA MATE training information
6. American Society of Health-System Pharmacists. “ASHP Urges DEA to Update Registration Process for Pharmacists.” March 4, 2025.
ASHP report describing a joint pharmacy-organization request for DEA to update its registration process and state authorization information to reflect newer state laws granting pharmacists controlled-substance prescribing authority.
Read the ASHP announcement