Securing full practice authority for nurse practitioners (NPs) and physician assistants (PAs) in all 50 states has been an ongoing effort, which will undoubtedly continue. We have repeatedly proven to be an integral part of health care in the United States. Yet, barriers remain that need to be removed for NPs and PAs in order for all people to receive equal and adequate care. One barrier is a federal law that does not allow NPs and PAs to prescribe the schedule III medication buprenorphine to individuals who have opiate use disorder (OUD). Ironically, we can prescribe this medication for pain management, but not for heroin or opioid dependence.


The Drug Abuse Treatment Act of 2000 (DATA 2000) dictates that NPs and PAs cannot prescribe buprenorphine for OUD. DATA 2000 states that only “qualifying physicians” (that is, those who complete an eight-hour course in opioid dependence) may prescribe buprenorphine for the purpose of treating individuals with OUD. 


This legislation is an example of how NPs and PAs are prevented from having full practice and prescription authority. DATA 2000 has created a shortage of providers who can treat OUD, a deadly epidemic. The current need for available healthcare providers to prescribe buprenorphine is urgent. 


On January 12, 2015, the White House Office of National Drug Control Policy (ONDCP) announced 2013 drug overdose mortality data from the CDC. The data show that the mortality rate associated with heroin increased for the third year in a row, representing a 39% increase from 2012 to 20131. These are statistics for heroin alone and do not include the overdoses caused by prescription opioids, which have more than quadrupled since 1999.2

It is important to examine the ethical aspects of this issue. There is a large pool of competent, well-prepared, and educated NPs and PAs who could help restore the lives of patients with an OUD. Imagine telling a 21-year-old patient who has already overdosed twice that it may be a few to several weeks before he or she can obtain buprenorphine. What could possibly be an NP’s or PA’s answer when he or she then asks, “What should I do in the meantime?” It would appear that politics and lack of awareness are standing in the way of access to care and improved quality of life for not only the individual who has OUD but for his or her family, friends, and the community. 


At this time, The Recovery Enhancement for Addiction Treatment (TREAT) Act, which would allow NPs and PAs the authority to prescribe buprenorphine for OUD, has been proposed in the House of Representatives (HR 2536), by Brian Higgins (D-NY-26), and Senate (S 1455), by Edward J. Markey (D-MA). It is the responsibility of not only healthcare providers but also members of the community to assist in managing this far-reaching epidemic, which will continue to grow if not prevented and treated as an urgent matter. Would the response be different if it were an epidemic such as Ebola? Of course it would. 


If you would like to see this legislation change, e-mail, write, or call your professional organization(s) and your local senators and representatives and urge them to support the TREAT Act. Voice your concerns about the limited access to treatment for those who have OUD, the subsequent increase in overdose victims, and the toll it is taking on our nation.


Christene Amabile, NP, received certification in addiction medicine from the International Nurses Society on Addictions and is a board-certified family nurse practitioner who works as an integration specialist at Horizon Health Services in Buffao, N.Y.

References

  1. 2013 drug overdose mortality data announced [press release]. Atlanta, GA: Centers for Disease Control and Prevention. www.cdc.gov/media/releases/2015/p0114-drug-overdose.html; Published January 12, 2015. 
  2. Warner M, Hedegaard H, Chen LH. Trends in drug-poisoning deaths involving opioid analgesics and heroin: United States, 1999-2012. NCHS Health E-Stats; Atlanta, GA: Centers for Disease Control and Prevention. www.cdc.gov/nchs/data/hestat/drug_poisoning/drug_poisoning.htm; Published December 2014.