Advances for PAs practicing addiction medicine

Both PAs and NPs who practice addiction medicine have seen progress made in 2016 to increase practice authority.
Both PAs and NPs who practice addiction medicine have seen progress made in 2016 to increase practice authority.

At the recent 2016 annual meeting of the American Academy of PAs (AAPA), the AAPA House of Delegates passed 2 important resolutions related to the treatment of opioid addiction and the safe prescribing of opiates for pain. The first resolution promotes increased patient access to opiate treatment programs, as well as the full utilization of PAs in opiate treatment programs, submitted by my specialty organization, the Society of Physician Assistants in Addiction Medicine (SPAAM). The second resolution offers guidance to PAs for safe opioid prescribing in the context of the nationwide explosion in opiate-prescribing deaths, submitted by the New York State Society of PAs (NYSSPA). The passage of these resolutions reflects the increased attention being paid to these issues, both inside and outside of the Academy.

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The AAPA, partnering with Nurse Practitioner (NP) leaders, has played a key role in promoting awareness of opioid addiction and its treatment. The Academy has made incredible headway in promoting federal legislation aiming to provide increased access to care by removing barriers facing both PAs and NPs who practice addiction medicine. The use of buprenorphine/naloxone (commonly branded as Suboxone) as replacement opiates for people with substance use disorders has previously been limited to physicians; this has been the case for almost 15 years, and getting this issue on the radar of federal legislators has taken years of hard work by the AAPA and other organizations.

It looks like this hard work is going to bear some fruit soon, as the US House of Representatives moved forward a number of bills that would allow PAs to prescribe this medication. This will next go to the US Senate, and hopefully this will lead to actual law sometime in the near future. Here's some information from the AAPA about this development.     

At the AAPA 2016 annual meeting, I was interviewed by The Clinical Advisor (click here to see the interview). In the video, I talk about some other recent, important developments for PAs interested in addiction medicine. One such development relates to the historic restriction by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) that allows only physicians to write orders in outpatient opiate treatment programs -- historically called “methadone clinics” -- and a new process approved by SAMHSA allowing both PAs and NPs to dispense methadone, buprenorphine/naloxone, and other agents used in opiate treatment program settings. This is an exciting development as well, with the potential to greatly increase access to care by removing obstacles to PAs and NPs to fully participate. Read about the exemption process here.

Finally, another symbolic but very positive development relates to the American Society of Addiction Medicine's (ASAM) decision to finally allow PAs and NPs membership in the association; until recently, membership was restricted to physicians only. Addiction medicine, as evidenced by the issues above, has long been a specialty in which PAs have not been able to fully function. This action by the ASAM is consistent with the nationwide move to increase access to opiate treatment by removing barriers to PA and NP practice.

For more information about PAs in addiction medicine, check out the web site for the Society of Physician Assistants in Addiction Medicine

Jim Anderson, MPAS, ATC, DFAAPA, is a physician assistant in Seattle.

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