BackgroundThe misuse of opioids is a health crisis in the United States. Medication treatment for opioid use disorder reduces negative health outcomes, but there are widespread shortages of appropriately trained and credentialed providers. Advanced practice registered nurses (APRNs) have recently become eligible for Drug Enforcement Administration (DEA) waivers that allow them to prescribe the most common medication, buprenorphine, but many factors might constrain their full participation in opioid use disorder treatment. Show
PurposeThis study aimed to describe practice and regulatory barriers and facilitators to APRNs offering buprenorphine treatment. MethodsThis mixed methods study integrated quantitative data on whether states’ APRN scope-of-practice regulations were correlated with obtaining DEA waivers and qualitative data from site visits to four states with high numbers of opioid overdose deaths. ResultsQuantitative analysis found that a higher percentage of APRNs were waivered in states in which APRNs could prescribe without physician oversight compared with states that require physician oversight. The average percentage of APRNs with a waiver was significantly greater in rural counties than in urban counties in states that do not require physician oversight of NPs (p = .006), as was the number of waivered APRNs per 100,000 population (p = .005). In contrast, the number of waivered APRNs per 100,000 population was lower in rural counties versus urban counties in states that required physician oversight (p = .005). Qualitative findings indicated that state regulations requiring physician supervision of APRNs, federal waiver restrictions on the number of patients treated, prior insurance authorization requirements for buprenorphine, insurance requirements of counseling services, and nurse attitudes toward addiction were barriers to buprenorphine prescribing. ConclusionQualitative findings indicate that waivered APRNs may not use the waiver due to practice and regulatory barriers. Requirements that physicians oversee APRN prescribing of buprenorphine may have slowed the growth of the opioid treatment workforce. Other regulations, organizational culture, and community support of buprenorphine treatment also affect APRN engagement in offering buprenorphine treatment. Keywords
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BiographyJoanne Spetz, PhD, is the Director, Philip R. Lee Institute for Health Policy Studies, and a Professor, Departments of Family & Community Medicine, Social and Behavioral Sciences, & Community Health Systems, University of California, San Francisco. BiographySusan Chapman, PhD, RN, is a Professor, Department of Social and Behavioral Sciences & Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco. BiographyMatthew Tierney, MS, RN, is a Professor, Department of Community Health Systems, University of California, San Francisco. BiographyBethany Phoenix, PhD, RN, is a a Professor, Department of Community Health Systems, University of California, San Francisco. BiographyLaurie Hailer, MA, MS, is an Independent Consultant, Fairfax, California. Article InfoFootnotesThis research was supported by the National Council of State Boards of Nursing (grant R101026) and the National Institute on Drug Abuse, US National Institutes for Health, grant R01DA047379. Dr. Spetz reports receiving consulting fees from the Center to Champion Nursing in America (American Association of Retired Persons) and Dennehy and Associates, LLC. Dr. Tierney reports receiving honoraria from Contemporary Forums, the American Society of Addiction Medicine, the California Society of Addiction Medicine, Cabezon Group, the Association for Multidisciplinary Education and Research in Substance Use and Addiction, the American Psychiatric Nurses Association, and Johnson & Johnson. IdentificationDOI: https://doi.org/10.1016/S2155-8256(21)00052-1 Copyright© 2021 National Council of State Boards of Nursing. Published by Elsevier Inc. All rights reserved. ScienceDirectAccess this article on ScienceDirectRelated ArticlesWhat are the ethical considerations to be followed to write a prescription?Considerations in Ethical Prescribing. Evaluate and define the patient's problem.. Determine the therapeutic objective of drug therapy.. Select an appropriate medication.. Provide patients with information, warnings, and instructions.. Monitor the patient regularly.. Consider drug costs when prescribing.. Can nurse practitioners prescribe controlled substances in Texas?Texas Board of Nursing - Education - Remediation Education. (a) APRNs with full licensure and a valid prescription authorization number are eligible to obtain authority to order and prescribe certain categories of controlled substances.
Can nurse practitioners prescribe controlled substances in Georgia?Georgia's Nurse Practitioner Prescribing Laws
Regardless of the terms outlined in the nurse protocol agreement, NPs in Georgia are not allowed to prescribe Schedule II controlled substances. Nurse practitioners are allowed to signs their own prescriptions in Georgia and do not need an MD co-signature.
Can nurse practitioners prescribe medication in Massachusetts?On all prescriptions, the physician's name must be present. Nurse practitioners in Massachusetts are prohibited from self-prescribing Schedule II, III, and IV drugs for personal use. NP's are also prohibited from prescribing Schedule II drugs to family members except in emergency situations.
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Advanced practice nurse prescribing of scheduled medications is affected most by
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