For some time, PAs and NPs were barred from prescribing medications to assist with opioid addiction treatment. That is no longer the case.
The Comprehensive Addiction and Recovery Act (CARA) was signed into law in July 2016. The legislation sought to improve access to addiction treatment across the country. One of the biggest changes it made was broadening the prescribing rules to include all nurse practitioners (NPs) and physician assistants (PAs).
This article explores the guidelines for physician assistants and nurse practitioners to follow to receive a waiver that allows them to prescribe medication assistance for opioid addiction. Why is this a step forward in addiction treatment?
CARA and Addiction Treatment
The loosening of the prescription privileges for NPs and PAs under CARA was designed to increase the volume of office-based medication-assisted treatments (MAT) for opioid addictions. The goal was to increase treatment with buprenorphine in physician offices and addiction treatment centers. The Substance Abuse and Mental Health Services Administration (SAMHSA) says:
Medications such as buprenorphine, in combination with counseling and behavioral therapies, provide a whole-patient approach to the treatment of opioid dependency.
Under CARA, NPs and PAs could prescribe buprenorphine in clinical settings, at least until October 2021. The American Society of Addiction Medicine (ASAM) reports that in order to take advantage of these expanded rules, NPs and PAs must:
- Complete 24-hours of training in the safe administering of MAT. The training must include opioid maintenance and detox; clinically appropriate use of MAT; patient assessment; treatment plans; staff roles and psychosocial services; and diversion control.
- Have a state licensure to prescribe Schedule III, IV, or V pain medications.
- If state law requires it, work closely under the supervision of a physician.
Other state laws may require additional qualifications. However, once all guidelines are met, the NP or PA may apply for a DATA 2000 waiver that they must send to the Drug Enforcement Administration (DEA). The DEA will then issue an ID that must be included on all buprenorphine prescriptions along with the clinician’s regular DEA registration. The NP or PA can then prescribe MAT for up to 30 patients in one year.
However, ASAM suggests that the Department of Human Services (HHS) is intending to further modify the rules to allow NPs and PAs who have prescribed buprenorphine to 30 patients in one year the right to prescribe for up to 100 additional patients under the waiver.
How This Helps Addiction Treatment
The expansion of prescribing rights for NPs and PAs will only help expand MAT in addiction treatment. Alcoholism & Drug Abuse Weekly points out that expanding these rules to clinicians with a nursing background “lends itself to treating addiction – not just writing a prescription.” Too, in many instances, mid-level providers have more extensive face time with patients, as a lower cost resource than physicians. Finally, there are more NPs and PAs in rural clinical settings.
We look at this expansion of the prescribing rules as an important step toward expanding MAT options for patients struggling with opioid addiction. It is an additional resource that we need to continue to fight the battle against opioid abuse.
Are you a clinician involved in the fight against the current opioid crisis? Contact us to find out more about referring patients to our facilities.
