Nurse Practitioner Prescriptive Authority for Buprenorphine

Abstract

The aim of this Policy Watch column is to provide an update on a much anticipated legislation, enacted in 2016, which enabled office-based opioid treatment (OBOT) with buprenorphine prescribing for the treatment of opioid addiction by nurse practitioners (as well as physician assistants). First, an overview of the Drug Addiction Treatment Act of 2000, which only permitted OBOT prescribing by physicians, will be described. It will be followed by a summary of the Recovery Enhancement for Addiction Treatment Act of 2015-2016. Finally, a review of the Comprehensive Addiction Recovery Act of 2016 will be provided, which includes information about important changes to OBOT regulations that enable NP prescribing of buprenorphine for the treatment of opioid addiction.

Changes in Buprenorphine-Naloxone and Opioid Pain Reliever Prescriptions After the Affordable Care Act Medicaid Expansion

“…Some states are focused on increasing the prescriber base by encouraging more physicians to obtain prescribing waivers and granting scope of practice to nurse practitioners and physician assistants, which is a change supported by recent federal regulations. 32 The 21st Century Cures Act provides $1 billion to states over 2 years to undertake system reforms that could also increase buprenorphine access for patients, such as care integration models that link office-based prescribers to specialty treatment clinics. States are also revisiting their prior authorization rules to ensure that they do not hinder access to buprenorphine, although many states continue to maintain limitations on buprenorphine prescribing in Medicaid.…”

Improving access to care through Advanced Practice Registered Nurses: Focus on perinatal patients with Opioid Use Disorder

“…The DATA 2000 waiver is what permits DEA licensed prescribers to be able to prescribe buprenorphine and that this could be done in the outpatient primary care setting. This expansion led the way for the 2018 Substance Use‐Disorder Prevention that Promotes Opioid Recover and Treatment for Patients and Communities (SUPPORT) Act in which the DATA 2000 waiver certification was further expanded to include certified nurse midwives (Fornili & Fogger, 2017; National Academies and of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; & Committee on Medication‐Assisted Treatment for Opioid Use Disorder, 2019). Prior to these legislative actions, only physicians were authorized to complete the training to obtain the DATA 2000 waiver certificate and the only healthcare provider permitted to prescribe buprenorphine for MOUD treatment.…”

States Should Remove Barriers to Advanced Practice Registered Nurse Prescriptive Authority to Increase Access to Treatment for Opioid Use Disorder

“…OTPs capable of dispensing methadone are concentrated in urban areas (in fact, most rural counties do not have one), and they have extensive waiting lists (Jones et al., 2015). DATA 2000 expanded access to MOUD by introducing the opportunity for office-based opioid treatment with buprenorphine and other products approved by the FDA within physician offices (Fornili & Fogger, 2017). Since 2002, the FDA has approved buprenorphine and buprenorphine/naloxone to treat persons with OUDs outside of OTPs (Tierney et al., 2015).…”