APNA Position: APRNs Prescribing Buprenorphine and other Medications for Opioid Use Disorder (MOUD)

Introduction

With more than 302,000 lives lost each year to suicide (> 50,0001), drugs (> 112,0002) and alcohol related causes (>140,0003), psychiatric-mental health nurses are at the forefront of saving American lives. The American Psychiatric Nurses Association (APNA) calls for comprehensive support, education, and policy to help this essential workforce practice to the full extent of its education, training, and licensure in order to address the extreme rise in deaths related to substance use disorders (SUD), and particularly the continued opioid crisis given the influx of fentanyl and other synthetic opioids.

According to substance use disorder experts, treatment of opioid use disorder with FDA-approved medications including buprenorphine (BUP) or medications for opioid use disorder (MOUD) can save lives and reduce the related consequences for individuals, their families, and society. However, there continues to be a shortage of providers who can provide these office-based treatments for persons who are diagnosed with opioid use disorder (OUD).

APNA takes the position that all nurses should practice to the full extent of their education and training4. Psychiatric-Mental Health Advanced Practice Nurses (PMH-APRNs), many of whom provide treatment to persons with OUD and other SUDs, are educated to provide both psychotherapy and prescribe medications. Depending on each state’s Nurse Practice Act, APRNs’ level of prescriptive authority varies

Discussion

The 2016 Comprehensive Addictions Recovery Act (CARA)5 and 2018 SUPPORT Act (Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities)6 expanded access to FDA-approved treatments by allowing Nurse Practitioners (NPs) and Physician Assistants (PAs) to prescribe buprenorphine (BUP) for opioid use disorders indefinitely, and Clinical Nurse Specialists, Certified Nurse Midwives, and Certified Registered Nurse Anesthetists to prescribe MOUD through October 2023. Currently, in order to obtain or renew their DEA Registration, prescribing practitioners of all disciplines need to complete 8 hours of continuing education related to the treatment and management of patients with opioid and/or other substance use disorders8.

There has been some improvement in access to BUP and MOUD treatment since these national legislative advances. Rural areas have seen a promising improvement in access to treatment for OUD, though there are still gaps to fill9. Restrictions to full nursing scope of practice at the state level continue to negatively impact access to care for a variety of populations, including those with opioid use disorders. APRNs who live in states where they are required by state law to be supervised by a physician or practice in collaboration with a physician are less likely to prescribe BUP or MOUD10. Many of these states have high rates of opioid addiction and overdose, and the greatest need for more practitioners to prescribe medications for opioid use disorder (MOUD)11.

According to a study addressing the cost-effectiveness of removing supervision requirements for Nurse Practitioners (NPs) prescribing buprenorphine, NPs in states with full practice authority produced more NPs prescribing BUP and treated more patients with OUD while saving almost $60 million12. Emphasis on the removal of prescribing practice restrictions for APRNs should be a collaborative effort across nursing organizations to improve access to high quality, safe, and cost-effective treatment for those suffering from OUD and other substance use disorders which continue to take the lives of hundreds of thousands of US citizens every year.

Conclusion

APNA remains steadfast in all efforts to support nurses in practicing to the full extent of their education, training, and licensure and supports efforts made to date to increase access to evidence-based treatment for opioid use disorders. Considering the continued need for better access to this care, APNA calls for continued full practice authority for PMH-APRNs to prescribe buprenorphine and other medications for opioid use disorder. This will increase access to high quality, cost-effective, and safe care for those with mental health and substance use disorders.

Approved by the APNA Board of Directors July 2, 2013.
Revised and approved June 10, 2020, February 2024

References

1.  Center for Disease Control & Prevention (2023) National Vital Statistic Surveillance Report. Retrieved from https://www.axios.com/2023/11/29/suicide-deaths-rates-record-high-2022-cdc
2.  Center for Disease Control & Prevention (2023). National Vital Statistics Surveillance. Provisional Drug Overdose Death Counts. Retrieved from: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
3.  National Center for Drug Abuse Statistics (2023). Alcohol Abuse Statistics. Retrieved from: https://drugabusestatistics.org/alcohol-abuse-statistics/#:~:text=Nearly%20100%2C000%20annual%20deaths%20are,are%20due%20to%20chronic%20misuse.
4.  American Psychiatric Nurses Association (APNA). (2015). APNA position: The future of nursing: Leading change, advancing health. https://www.apna.org/i4a/pages/index.cfm?pageid=6235
5.  Congress, U. S. (2016). Comprehensive Addiction and Recovery Act of 2016. In US Congress.
6.  Congress, U.S. (2018). H.R.6 SUPPORT for Patients and Communities Act. Retrieved from: https://www.congress.gov/bill/115th-congress/house-bill/6/text#toc- HE7D6B79AFB0447CD9D2F6F189A1586FE
7.  Substance Use & Mental Health Administration (2023). Waiver Elimination (MAT Act). Retrieved from: https://www.samhsa.gov/medications-substance-use-disorders/waiver-elimination-mat-act#:~:text=Section%201262%20of%20the%20Consolidated,opioid%20use%20disorder%20(OUD).
8. US Department of Justice: Drug Enforcement Agency (2023). Medication Assisted Treatment: Requirements for training for Medication Assisted Treatment as part of the MATE Act. Retireved from: https://www.deadiversion.usdoj.gov/pubs/docs/MATE_training.html https://www.healthaffairs.org/do/10.1377/hblog20191105.242580/full/
9.  Andrilla, C. H. A., Moore, T. E., Patterson, D. G., & Larson, E. H. (2019). Geographic Distribution of Providers with a DEA Waiver to Prescribe Buprenorphine for the Treatment of Opioid Use Disorder: A 5- Year Update. The Journal of Rural Health, 35(1), 108-112.
10. Spetz, J., Toretsky, C., Chapman, S., Phoenix, B., & Tierney, M. (2019). Nurse Practitioner and Physician Assistant Waivers to Prescribe Buprenorphine and State Scope of Practice Restrictions. JAMA: Journal of the American Medical Association, 321(14), 1407-1408.
11. Moore, D. J. (2019). Nurse practitioners’ pivotal role in ending the opioid epidemic. The Journal for Nurse Practitioners, 15(5), 323-327
12. Hughes, PM, Ramage, MSN, Gigli, KH & Tak, CR (2023). Assessing the Cost-Effectiveness of Removing Supervision Requirements for Nurse Practitioners Prescribing Buprenorphine for Opioid Use Disorder. Journal of Nursing Regulation, 14(3), 44-54.