Scope-of-Practice Restrictions Affect the Nurse Practitioner Role in Addressing Opioid Abuse

The following article is a part of conference coverage from the American Psychiatric Nurses Association (APNA) 34th Annual Conference, held online from September 30 to October 4, 2020. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading nurses in psychiatry. Check back for more from APNA 2020.

 

In states with greater scope-of-practice (SOP) restrictions on nurse practitioners (NPs), there were fewer NPs who are able to provide treatment services for patients with opioid use disorder (OUD), according to study data presented at the American Psychiatric Nurses Association 34th Annual Conference, held online from September 30^th to October 4^th, 2020.¹

There is currently a shortage in the number of providers who are authorized to prescribe medication-assisted treatment (MAT) for the management of opioid use disorder, according to Bethany Phoenix, PhD, RN, of the University of California, San Francisco. NPs have the ability to prescribe MAT as the result of federal legislation, but in some states, more restrictive SOP laws limit their ability to increase patient access to treatment, including buprenorphine. Dr. Phoenix and colleagues conducted a study combining data from the national database of MAT-waivered providers with qualitative interview data to examine barriers to NP involvement in prescribing MAT.

The study authors visited 4 states with rates of high opioid overdose deaths that differed in NP autonomy and amount of NPs who have MAT waivers. These states included West Virginia (high autonomy; low percentage of NPs waivered), New Mexico (high autonomy; high percentage of NPs waivered), Michigan (low autonomy; low percentage of NPs waivered), and Ohio (low autonomy; high percentage of NPs waivered).

Out of 76 study participants, 40% were NPs, 9% were physicians, 17% were other advanced practice registered nurses, 17% were agency leaders, and 17% were policymakers or regulators.

The study authors noted that greater SOP restrictions were linked to a lower percentage of NPs with MAT waivers.² In states with restrictive SOP laws, NPs reported difficulty in finding a supervising physician with a MAT waiver as a barrier to providing patients with MAT services.

Other reported barriers for NPs to obtain and use MAT waivers included regulations other than SOP, such as Medicaid. Stigmas surrounding OUD and MAT may have an additional impact on an NP’s decision to pursue a waiver and a patient’s decision to seek treatment, according to the study authors.

Participants stated that the holistic nature of nursing education can serve as an asset in OUD treatment settings for NPs and called for collaboration among state leaders to push back against regulatory restrictions to combat the opioid crisis.

The authors concluded that state laws, practice cultures, and the stigma of the opioid epidemic all play a role in determining how many NPs will pursue MAT waivers, and full practice authority could increase NPs’ ability to provide MAT services.

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References

1. Phoenix B, Tierney M, Chapman S, Spetz J. Nurse practitioner participation in medication-assisted treatment for opioid use disorders: impact of state scope of practice regulation. Presented at: APNA Annual Conference; September 30-October 4, 2020.  Poster 163.
2. Spetz J, Toretsky C, Chapman S, Phoenix B, Tierney M. Nurse practitioner and physician assistant waivers to prescribe buprenorphine and state scope of practice prescriptions. JAMA. 2019;321(14):1407-1408.