July 2, 2013

APNA Supports the Expansion of APRN Prescriptive Authority to Include Prescription of Buprenorphine & Buprenorphine/Naloxone (Suboxone)

Buprenorphine, an opioid receptor partial agonist, is a Schedule III drug that currently can only be prescribed by physicians with specialized training and separate DEA authorization. Advanced practice psychiatric mental health nurses treat chronic pain patients as well as patients who have addictions to various substances. Most advanced practice nurses (APRNs) have prescriptive authority to prescribe schedule II-V drugs, including methadone in the treatment of chronic, severe pain, yet cannot prescribe buprenorphine due to restrictions in the Drug Addiction Treatment Act of 2000.

The number of patients who are addicted to opiates is rising at an alarming rate. The Veterans Administration (VA) is seeing a trend of veterans returning from deployment who are addicted to opiates and is predicting these numbers will continue to grow in the near future. Experts in addiction medicine identify that treatment of opiate addiction with buprenorhine or buprenorphine/naloxone can save lives and reduce the consequences of opiate addiction for the addicted person, their families and society. Currently, there is a shortage of physicians who can provide office-based treatment for persons who are addicted to opiates and some states do not have anyone trained to provide outpatient treatment to this population.

In spite of difficulties posed by current state Board of Registered Nursing collaborative practice requirements and a paucity of physicians who are currently able to prescribe these medications, experts within the VA and addiction medicine communities are in favor of training more health professionals, including APRNs, to enable them to prescribe opiate antagonists, agonists/antagonists and partial antagonists in the treatment of opiate addiction. In addition, many states currently allow APRNs to prescribe schedule II-V substances, including opiate medications. It is inconsistent to not allow these APRN nurses to receive training in order to prescribe buprenorphine or buprenorphine/naloxone. The American Psychiatric Nurses Association therefore fully supports the expansion of advanced practice registered nurses' prescriptive authority to include the prescription of buprenorphine and buprenorphine/naloxone (Suboxone) in the treatment of persons who are addicted to opiates.

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