PAs and NPs may be gaining greater scope of practice in the fascinating field of methadone maintenance.

Earlier this month, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) released draft guidelines for accrediting opioid treatment programs that would enable PAs and NPs to assess, diagnose and admit patients with opioid addiction into treatment programs at federally approved and regulated clinics – practices that are currently limited in many states.

The American Academy of Physician Assistants (AAPA) has played an important role in moving this scope of practice advancement forward. AAPA Senior Director of Federal Advocacy Sandy Harding has made it a high priority, and the announcement reflects her important and patient-centered work.


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One of the major challenges for clinicians working in this focused subspecialty is the almost complete lack of knowledge about methadone treatment that pervades the medical community. My first job as a PA was in a methadone maintenance facility, and fortunately the state of Washington has had good regulations in place for quite some time, allowing PAs and NPs to practice appropriately. I’m about to return to the field part-time, and am thrilled to be able to do so.

But ongoing discussions I’ve had with MDs, PAs and NPs indicate great apprehension about this subspecialty, as well as patients in methadone treatment. Methadone clinics are frequently seen as scary black holes, thought to be unsafe and unclean, a place where marginalized heroin addicts disappear every day to receive drugs in some unknown manner.

Of course the problem is not the clinician who has this apprehension, but rather the lack of education about addiction, particularly methadone. Much of this may relate to the inaccurate, but widely held perception that methadone treatment is an exotic and bizarre anomaly, functioning deep in the folds of the medical system.

There are in fact already hundreds of thousands of patients in methadone maintenance treatment, and that number is expected to explode when the Affordable Care Act kicks in. Currently, there are almost 300,000 patients receiving this type of treatment, making it extremely likely that PAs in all settings will encounter them in the future.

Failure to address knowledge gaps about methadone maintenance will have a growing negative impact on patient care. PAs unfamiliar with methadone maintenance place their patients and themselves at grave risk. These patients have unique pharmacological needs. Lack of familiarity with how to properly treat them can increase their risk for fatal medication overdose, severe pain due to misconceptions about methadone maintenance and pain control, and other significant health risks including cardiovascular, psychiatric, obstetric, infectious and other systemic complications.

We PAs and NPs have our work cut out for us, and we need to intensify our individual and organizational efforts to meet the needs of this growing and fascinating subspecialty.

Jim Anderson, MPAS, PA-C, ATC is chair of the American Academy of Physician Assistants Health Disparities Work Group, founder of Physician Assistants for Health Equity and faculty of the Department of Anesthesia and Pain Medicine at the University of Washington School of Medicine in Seattle.