Why NPs, PAs in some states cant prescribe buprenorphine to treat opioid miuse, despite a federal allow allowing them to do so

More than 700 nurse practitioners (NPs) and physician assistants (PAs) this month received federal approval to prescribe the anti-addiction medication buprenorphine—but laws in more than half of the 50 states are likely to block non-physicians from gaining such prescribing authority.

Background

According to Stateline, only about 10 percent of individuals with a substance use disorder receive treatment. That shortage is largely due to a dearth of providers—particularly those authorized to prescribe buprenorphine, an anti-addiction medication that prevents withdrawal symptoms and curbs cravings, Stateline reports. A federal license is needed to prescribe the drug.

T help facilitate access to treatment, Congress in 2016 passed the Comprehensive Addiction Treatment and Recovery Act (CARA). Among other provisions, the law allows NPs and PAs to seek a federal license to prescribe buprenorphine. Previously, only doctors had been permitted to apply for such a license, and in the 15 years since the drug was approved, less than 39,000 doctors have sought the license.

Obama signs bill to combat opioid misuse

More providers can prescribe the drug, but obstacles remain

Since CARA was enacted, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration have issued relevant licenses to 560 NPs and 184 PAs. And according to SAMHSA's Mitra Ahadpour, applications are likely to grow as more health care professionals learn about the CARA provision and take a no-cost, three-day online training course.

But the law's effect might be limited: 28 states currently have scope-of-practice laws that bar NPs or PAs from prescribing buprenorphine unless they are collaborating with a physician who has a license to prescribe the drug, Stateline reports, while three states—Oklahoma, Tennessee, and Wyoming—explicitly bar NPs from prescribing the drug with or without a physician's supervision.

A few states have recently changed their scope-of-practice laws. West Virginia, which ranked No. 1 in overdose deaths, updated its scope of practice law in 2016 to allow NPs to diagnose, prescribe, and treat patients without a doctor's supervision—except when it comes to prescribing schedule II drugs, such as Percocet, Vicodin, and OxyContin. South Dakota gave NPs full practice authority in February.

But changing scope-of-practice laws can be tricky, Stateline reports. Medical societies representing doctors can be reluctant to support such changes, with some saying NPs lack necessary medical training.

As Taynin Kopanos, vice president of state government affairs for the American Association of Nurse Practitioners, put it, "Although nurses care very much about getting more treatment to people who need it, and governors and lawmakers do as well, scope of practice laws are not likely to be changed overnight just because of the opioid epidemic" (Vestal, Stateline, 4/21; Rappleye, Becker's Hospital Review, 4/24).

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As the number of medications rises, so does the opportunity for medication errors, such as incorrect dosages, drug interactions, and serious side effects. By some estimates, the U.S. spends as much money correcting these medications problems as we do on the drugs themselves.

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