By Christene Amabile
The article, “On track for 570 opiate deaths in 2016, Erie County steps up response,” in the April 6 Buffalo News in part focused on the shortage of health care providers who can prescribe medication assisted treatment for opiate use disorders.
It noted the small number of physicians who are certified to prescribe buprenorphine (trade names: Suboxone, subutex and Zubsolv). Even when certified, physicians can prescribe to only 100 clients at a time.
Unfortunately, although nurse practitioners (NPs) and physician assistants (PAs) provide medical care to millions of people daily, and are an integral part of health care, a federal law created in 2000 prohibits NPs/PAs from prescribing buprenorphine to treat addictions. Buprenorphine is a schedule III controlled substance, which when utilized as prescribed does not induce a “high” and has less risk for overdose than do other prescription opioids and heroin. Ironically, NPs and PAs can prescribe buprenorphine for pain management.
As a nurse practitioner with a subspecialty in addiction medicine, it is an ongoing struggle to provide individuals with timely and effective treatment given the current regulations.
The alarming shortage of providers who can prescribe buprenorphine makes the treatment inaccessible to individuals in need. Imagine that you were in a serious car accident and subsequently prescribed opioid analgesics by a pain specialist. Although the medication was carefully monitored, eventually you started using more than what was prescribed. Although no longer in pain, now you are addicted to opioids. So, you seek out an easily accessible and inexpensive substitute: heroin.
You decide that it is time to get help because your entire life is crumbling. You call your primary care provider (an NP), who provides all your medical care, medications, etc. You explain your situation and that you are interested in buprenorphine. She regrets to tell you that even though she is also certified in addiction medicine she cannot give you a prescription for the medication. And, you might need to wait at least a few weeks and maybe more to get an appointment with a physician who can prescribe buprenorphine.
Allowing NPs/PAs with addiction medicine training seems an obvious and inexpensive way to assist with the shortage of treatment providers. We have the potential workforce to meet the demands of this crisis and are not utilizing it. Proposed federal legislation known as the TREAT Act would allow nurse practitioners and physician assistants to prescribe buprenorphine for addiction. It would also eliminate the 100-client limit for physicians.
This national crisis is affecting everyone. Please assist now by voicing your concerns.
Christene Amabile, FNP-BC, CARN-AP, of Grand Island, is a family nurse practitioner.