Expand Legislation — Allow Midlevel Practitioners to Help in the Fight Against Opioid Addiction



The abuse of heroin and narcotic pain medications in the United States is a major problem affecting hundreds upon thousands of Americans from all walks of life. Opioid addiction is a major reason that our emergency rooms, our courts, and our jails are crowded.

Buprenorphine is the only available medication approved in the United States that can be prescribed from a doctor’s office to treat opioid addiction. Under the Drug Addiction Treatment Act of 2000, an amendment to the Controlled Substances Act, passed by the U.S. Congress, doctors who complete an 8 hour training course can be certified by the Drug Enforcement Agency to prescribe buprenorphine.

The certification is limited, however, to medical providers who have a MD and shuts out midlevel practitioners, who are more likely to choose to treat opioid-addicted individuals, from joining in the fight against this chronic and relenting disease of opioid addiction. Midlevel practitioners such as nurse practitioners and physician assistants are allowed to prescribe opioid narcotic medications yet are restricted from prescribing the much less harmful buprenorphine!

The only other option for opioid substitution therapy is methadone and methadone is only available from a limited number of methadone clinics which treat about 15% of all those people who desperately need medical treatment. Over a million people continue to need treatment for their opioid dependency and not enough physicians are stepping up to the plate to take on this burdening challenge!

Given that buprenorphine is effective and safe with very low risk of overdose and a much milder withdrawal process than methadone and given the huge need for providers to take on this challenge of treating the opioid addicted population, we all need to petition our congressmen and women to expand the law, allowing midlevel practitioners to prescribe buprenorphine to treat this chronic medical condition that impacts every level of our society.

To listen to one mother’s experience, please click here. The 1 minute video you will see is from the National Alliance of Advocates for Buprenorphine Treatment website.

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3 Responses to “Expand Legislation — Allow Midlevel Practitioners to Help in the Fight Against Opioid Addiction”

  1. nkathy206 Says:

    After ten years of managing a substance abuse program for parolees in Jamaica, Queens, I was so happy to see the advent of buprenorphine as an alternative to methadone. Too often, the methadone was being sold by the patients to obtain more heroin, or was being abused rather than utilized therapeutically. It would be another great step for midlevel practitioners to be certified, and social workers and substance abuse counselors are one group that are engaged in advocacy efforts currently. Often, it is a nurse practitioner or PA seeing the patient in the substance abuse program, where physician hours are limited due to cost containment, and getting the patient back again to see a physician can be difficult. Great entry, thanks!

  2. anthonypho Says:

    Thanks for bringing light to an important issue for mid-level providers. As a nurse practitioner student it’s very frustrating to navigate the state-to-sate licensure issues for prescriptive rights. For example although an NP may go to school and train in one state where they have prescriptive rights they may lose these rights when they obtain licensure in another state.

    It would ideal for mid-level practitioners to have national standards for such prescriptive authority or perhaps specialized authority in specific substance abuse treatment environments. Unfortunately I just don’t see this happening any time soon especially given the existing skepticism around methadone treatment and relative newness of buprenorphine.

  3. nikitopp Says:

    I think that this is a really great issue to bring attention to. In medical school I worked at a prenatal clinic that catered only to women that were on subutex treatment. There were only two obstetricians at the entire facility that even wanted to work with this patient population, and then only one of the obstetricians had prescribing rights for buprenorphine. The doctors were overburdened with many job responsibilities, so a large burden of the patient’s addiction care was organized and delivered by the clinic’s nurse practitioner.

    The clinic would constantly run-up against problems due to the fact that the nurse practitioner would be with the patients doing counseling and follow-up, but when it was time to get prescriptions together she had to track down the one ob that could prescribe the subutex. This was a daily occurrence, as the doctor was either delivering a baby, doing a c-section, or working at the other clinic in the other side of the city. Everyone at the clinic agreed that it was ridiculous that the nurse practitioner could not get the rights to write the prescriptions herself, seeing as she was the person mainly managing the care. It wasted significant time, and made an already arduous and time-consuming task even more so.

    That being said, I think that anyone that is given the rights to prescribe buprenorphine, regardless of medical degree, needs to have significant experience with addiction. There are risks involved with buprenorphine, and there is the potential for abuse, so it is important that anyone working with this patient population needs to have experience before being given any prescription rights.

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