Inclusion of CNS in CARA 2016

The Comprehensive Addiction and Recovery Act (CARA), signed into law July 2016, was a comprehensive effort to address the current US opioid epidemic. While the legislation expanded buprenorphine prescribing privileges to nurse practitioners for five years if they complete 24 hours of training, the law does not mention Clinical Nurse Specialists. Use the below instructions and suggested text to advocate for the recognition of PMH-CNSs in order to expand access to this important treatment. Also, be sure to check out these Clinical Nurse Specialist Resources, many of which will help you build your case when advocating for Clinical Nurses Specialists in a variety of arenas.

Contact your senator

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  • Use the drop down menu in the top left to select your state.
  • Select your Senator and click on their contact link.
  • Enter your information, copy the below text and paste into the message field (edit as you wish), and hit send/submit.

Contact your Representative

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  • Enter your zip code in the box in the top right corner and hit go.
  • Select your Representative and click on their contact link.
  • Enter your information, copy the below text and paste it into the message field (edit as you wish), and hit send/submit.

Dear [Senator/Representative Name],

I am a Psychiatric-Mental Health Clinical Nurse Specialist (PMH-CNS) who lives in your district and works on the front-lines of mental health and substance use care to address the increasing opioid crisis in our country. I know firsthand how the opioid epidemic impacts our community and work to help adults and teens towards recovery from this addiction. Part of this treatment includes the use of Buprenorphine (Suboxone, Subutex), a medication approved by the U.S. Food and Drug Administration (FDA) and whose development was supported by the National Institute on Drug Abuse (NIDA). Buprenorphine saves lives and reduces the consequences of opiate addiction for the addicted person, their families, and society. While this prescription may be filled by qualified prescribers, there is currently a shortage of providers able to deliver this treatment, and some states do not have anyone trained to provide outpatient treatment to this population. That is why I was disappointed to learn that the 2016 Comprehensive Addiction and Recovery Act (CARA), whose stated intent was to expand access to this Medicated Assisted Treatment (MAT) for opioid use disorders, does not name PMH-CNSs as eligible to obtain a waiver through the DEA to prescribe this medication. PMH-CNSs have similar educational background and access to training as Nurse Practitioners (NPs) who are currently successfully prescribing  and managing these medications under CARA. According to the American Psychiatric Nurses Association, "psychiatric advanced practice nurses, whether they practice under the title of CNS or NP, share the same core competencies of clinical and professional practice” (2010). Therefore, I respectfully request that the language in the CARA regulation be changed to allow qualified CNSs to obtain a waiver through the DEA to prescribe buprenorphine. By allowing CNSs to prescribe this MAT you would not only enable more than 7,500 CNSs to treat the opioid epidemic more directly, you would also help to reduce overall costs and increase access to care, especially for those in rural areas.

As your constituent and a Clinical Nurse Specialist, I respectfully ask that you reevaluate the regulations in CARA that currently exclude psychiatric-mental health advanced practice nurses who are certified as Clinical Nurse Specialists.

Thank you for considering my request and I am available to you to provide any further information.

[Your Name]


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