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January 26, 2018

NPs, PAs can now prescribe buprenorphine to treat opioid misuse

Daily Briefing

    The Drug Enforcement Administration (DEA) on Tuesday updated a regulation to allow NPs and physician assistants (PAs) to apply for waivers to prescribe and dispense buprenorphine—a move that experts say will boost access to care in rural communities.

    Your top resources for combatting the opioid epidemic in one place

    According to CDC, the misuse of prescription drugs is one of the leading causes of death among U.S. residents, with opioid misuse accounting for more than 42,000 deaths in 2016—the highest annual number of deaths for opioid misuse on record. CDC research has shown the issue is more severe in rural areas, which tend to report higher numbers of opioid-related deaths than urban areas, Reuters reports.

    An attempt to help rural communities

    DEA's announcement brings the agency in line with the Comprehensive Addiction and Recovery Act (CARA) signed into law in 2016.

    CARA adjusted the Drug Abuse Treatment Act of 2000, which permitted only physicians who had registered with the DEA as doctors and as operators of narcotic treatment programs to prescribe buprenorphine, Becker's Hospital Review reports. However, a 2017 study from the National Rural Health Association found those restrictions left 53% of rural counties without a physician able to prescribe buprenorphine. Overall, 90% of the physicians able to prescribe the treatment practiced in urban counties, leaving some 30 million people without access to a prescribing physician.

    DEA estimated that, under the regulatory change around 5,000 mid-level practitioners and almost 43,000 practitioners will now be able to apply for waivers to prescribe buprenorphine.


    Experts praised the move by the DEA, saying the expansion is a positive step, the Grand Forks Herald reports. Anne Stephen, the East region CMO for Essentia Health, said "This is a great thing. The more that we can provide support for our patients in all areas, but specifically with opioid dependence, the better service we can provide."

    David Fiellin, a professor of medicine, emergency medicine, and public health at Yale School of Medicine, agreed. "This action reflects this work and the ongoing need to further expand access to the most effective treatment for opioid use disorder."

    Carol Falkowski, the director of Drug Abuse Dialogues in Minnesota, said, "To broaden out the prescribers is very good public health policy, and I think this is a positive step." She added, however, that the move is long overdue. "There is no other … chronic disease for which there is so much resistance to the use of medication and its treatment," she said. "We need to move forward in Minnesota and nationwide to make the accessibility of medication treatment for opiate addiction more broadly available" (Reuters, 1/23; Lundy, Grand Forks Herald, 1/23; Zimmerman, Becker's Hospital Review, 1/24).

    Next: How to combat the opioid epidemic

    Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties.

    This report outlines three imperatives to guide hospitals and health systems in their efforts to reduce the impact of inappropriate opioid prescribing and misuse.

    Get the Report

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