Many people who need treatment for substance use disorders are not receiving it. Though there are many physicians with waivers to provide buprenorphine for medication-assisted treatment, they tend to be clustered in and around urban centers,1 leaving many rural counties without access to treatment.
In fact, half of all counties in the United States do not have a physician licensed to prescribe buprenorphine. To widen the availability of medication-assisted treatment using buprenorphine, the 2016 Comprehensive Addiction and Recovery Act authorized SAMHSA to allow nurse practitioners (NPs) and physician assistants (PAs) to apply for waivers to prescribe buprenorphine to treat opioid addiction.
According to the 2016 Surgeon General's Report, effective treatments2 for persons with substance use disorders specifically target different aspects of the disorders (such as overdose, withdrawal) as well as co-morbid disorders or issues (such as mental disorders, HIV infection, intimate partner violence).
To receive the federal waiver, NPs and PAs must complete 24 hours of training (triple the 8 hours required of physicians). To make training more accessible to NPs and PAs, including those in remote areas, British pharmaceutical company Indivior has provided a grant for free online training.3
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However, one roadblock to fully utilizing NPs and PAs as a force for treatment is the law in certain states. More than half of U.S. states specifically restrict or prevent NPs and PAs from prescribing buprenorphine under their scope of practice laws. Several states prohibit nurse practitioners and physician assistants from prescribing buprenorphine under any conditions. In 28 states,4 NPs must work in collaboration with a physician who is licensed to prescribe buprenorphine—a restriction that allows for increases in availability of buprenorphine but does nothing to increase its geographic accessibility.
A few states (such as Oregon, South Dakota, and West Virginia) are adapting state laws to allow NPs and PAs to prescribe if they obtain the federal waiver.
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ANNOUNCEMENT
This is the first issue of SAMHSA's Buprenorphine Prescriber News. Each issue will have a brief article or two about the opioid crisis, addressing topics such as opioid prescription practices, opioid use, opioid overdoses, opioid overdose deaths, buprenorphine treatment, and policy and program issues and actions, as well as announcements about upcoming events and links to helpful resources. We hope you find it useful. |
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QUICK LINKS
Existing Prescribers
Interested Practitioners
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