What I prescribe
As a Texas PMHNP-BC with DEA registration, I prescribe a wide range of psychiatric medications:
- Non-controlled medications: SSRIs, SNRIs, mood stabilizers, antipsychotics, and non-stimulant ADHD medications (atomoxetine, guanfacine ER, clonidine ER, bupropion, viloxazine).
- Controlled medications, when clinically indicated and after a complete evaluation: benzodiazepines short-term for acute anxiety (Klonopin, Ativan, Xanax, Valium) and non-benzodiazepine sleep medications (Ambien, Lunesta, Sonata).
What I do not prescribe
- Stimulants for ADHD (Adderall, Vyvanse, Concerta, Ritalin, Focalin, Dexedrine, and similar Schedule II stimulants). I treat adult ADHD with non-stimulant medication and behavioral strategies. If you require stimulant management, I am glad to coordinate with your existing prescriber or refer you to a colleague who can provide it.
- Ketamine, Spravato (esketamine), and buprenorphine — referred to specialty providers.
What does NOT happen at the first visit
Visit 1 is a 60–90-minute evaluation. I will not write a benzodiazepine or sleep-medication prescription on the first visit. I review your history, prior records, and goals first. If a controlled medication is appropriate, we begin it at a follow-up visit, typically within 1–2 weeks. This applies even if you are transferring care from another prescriber on a stable regimen — the second-visit start is for safety and continuity, not as a barrier.
Treatment agreement, PDMP, and drug screening
Before I prescribe any controlled medication, you will sign a Controlled Substance Treatment Agreement that explains expectations on both sides. I review the Texas Prescription Monitoring Program (PMP) at intake and at every refill. A urine drug screen may be requested at intake and at random intervals. Positive results inconsistent with our plan, or refusal of a requested screen, ends the controlled-medication portion of treatment — but we work together to maintain your overall psychiatric care.
Refills
- Schedule IV (benzodiazepines, Z-drugs): typically 30–90 days.
- Refill requests are handled at scheduled visits, not by phone or message between visits. Plan ahead.
Lost or stolen prescriptions
Lost, stolen, or damaged controlled-medication prescriptions are not replaced. File a police report and contact your pharmacy. We document the report in your chart. After two such incidents in 12 months, controlled-substance prescribing is paused.
Telehealth
Per the DEA/HHS extension through December 31, 2026, I can initiate and continue Schedule IV prescribing via telehealth for patients physically located in Texas at the time of the visit. This may be revisited as DEA finalizes permanent rules.
Transferring care from another prescriber
If you are currently on a benzodiazepine from another prescriber, I am glad to consider continuing your regimen. Please bring (1) your most recent prescriber's note documenting diagnosis and current dose, (2) a complete medication list, and (3) signed releases for prior records. I may continue, adjust, or taper based on my evaluation. There is no guarantee that I will continue the same medication or dose; I will explain my reasoning. If you are currently on a stimulant from another prescriber and want to continue that medication, please plan to keep your existing prescriber for stimulant management — I do not take over Schedule II stimulant prescribing. I am happy to handle the rest of your psychiatric care alongside their stimulant management.
Tapering off benzodiazepines
I welcome patients who want to come off long-term benzodiazepines safely. I work at your pace using evidence-based tapering protocols (typically 10–25% reductions every 2–4 weeks, with personalization). When clinically appropriate, I partner with a compounding pharmacy for custom doses that aren't available commercially. Tapering is a skill set I value and protect time for.
What I do not do
- Prescribe stimulants for ADHD (refer out or coordinate with existing prescriber).
- Prescribe controlled substances on visit 1.
- Replace lost/stolen Rx.
- Prescribe controlled substances by telehealth for patients outside Texas.
- Prescribe ketamine, Spravato (esketamine), or buprenorphine (refer out).
- Continue controlled substances when treatment-agreement terms are violated.
Why this policy exists
These rules are not gatekeeping. They exist to keep treatment safe, defensible, and aligned with state and federal requirements — and to make sure controlled medications, when prescribed, are doing more good than harm. If you have questions about how this policy applies to your situation, please ask at our first visit.