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Exploring the Role of PAs and NPs in Addiction Medicine


Physician Assistants (PAs) and Nurse Practitioners (NPs) roles have expanded in the general field of healthcare delivery. In many health systems and even in solo family practice offices, the PA or NP helps stretch the physician provider by taking on many of the same tasks.

In the field of addiction medicine, there has been some debate about the role of PAs and NPs. This article examines some of the latest developments in the field that have led to the expansion of these mid-level provider roles.

How have these medical professionals advanced addiction treatment for an increasing patient population? What duties can both PAs and NPs perform in an addiction medicine practice?

Addiction Medicine and the Mid-Level Provider

In addiction medicine today, PAs and NPs can assist with the patient assessment, testing, developing treatment plans, educating patients, and writing prescriptions. These roles help drug and alcohol rehab and pain management facilities stretch their scope of services to keep up with a burgeoning patient population.

The laws governing these mid-level professionals in addiction medicine continue to expand.

Some of the recent developments include:

  • According to Huffington Post, in 2016 the American Academy of Physician Assistants (AAPA) endorsed resolutions allowing PAs to provide care in opiate treatment programs. They also passed guidelines for safe prescribing of opioids by PAs.
  • In early 2015, the Substance Abuse and Mental Health Services Administration (SAMHSA) released their guidelines for opioid treatment facilities and they did not allow PAs and NPs to admit patients, prescribe and dispense opioid agonist agents. However, SAMHSA did suggest a process for applying for exemption from these rules. As per 42 CFR8.11(h), an opioid treatment provider could apply for exemption from the rules limiting prescribing to physicians in these facilities. The AAPA has a white paper that details the compliance rules for waiving the SAMHSA guidelines. The Society of Physician Assistants in Addiction Medicine (SPAAM) also has a good paper on the steps necessary to seek the exemption.
  • Another positive development affecting mid-level practitioners in addiction medicine came from the American Society of Addiction Medicine (ASAM) ruling that allows NPs and PAs to join their organization. Previously membership had been restricted to physicians, so this is a symbolic step that elevated mid-level providers by removing some of the barriers that had thwarted them from full clinical duties in addiction medicine.

Addiction medicine

It is all hands on deck in the battle to stop the opioid epidemic.

It is clear that PAs and NPs are needed in addiction medicine. The U.S. Centers for Disease Control (CDC) point out that overdose deaths from prescription opioids have risen four-fold since 1999. To fight this battle the addiction medicine community must work to enable NPs and PAs so that they can join opioid treatment facilities and their physician providers in doing what is necessary to save lives. Allowing the waiver that lets mid-level providers prescribe buprenorphine is just the first step toward giving these professionals the tools they need at a time we need them the most. Physicians Practice calls it an “all hands on deck” approach. Given the size of the opioid epidemic, we need all the help we can get.

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