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June 15, 2018

Nurse Practitioners Must Play Key Role in Legislation to Address Opioid Crisis

Joyce Knestrick, PhD, CRNP, FAANP

America’s opioid abuse problem is now worse than ever. This has prompted Members of Congress to again roll up their sleeves to continue to build on the Comprehensive Addiction and Recovery Act (CARA), which passed with bipartisan support in 2016. While CARA was a significant push in the right direction, legislators from both sides of the aisle agree more needs to be done to address this still-escalating crisis – and it needs to happen soon.  In my own rural city, we have experienced countless opioid-related deaths. At one point, we lost seven members of our community in a single hour in a single day. It is time for lawmakers, health care providers and communities to fight back.

Critical to the debate is how to ensure our nation has a sufficient health care infrastructure to manage substance use disorder, and appropriately treat chronic pain – including facilities and trained professionals equipped to handle patient demand for care. More than 20 percent of individuals with chronic pain have misused their opioid prescription, and roughly 10 percent have substance use disorders. Without accessible prevention and treatment options available, the problem will only continue to spiral out of control.

Lawmakers are working closely with the health care providers and communities to make localized, evidence-based treatment the priority. CARA laid the foundation to make treatment more accessible and specifically recognized the importance of nurse practitioners (NPs) in delivering such care. Already NPs treat patients and prescribe medicine in all 50 states, and in 22 states, plus the District of Columbia, patients have full and direct access to NP care, providing patient choice in health care and leading the way to better health care access.

At a crucial juncture in the opioid epidemic, CARA recognized the need for high quality, qualified health care providers to provide medication assisted therapies to help treat patients struggling with opioid abuse disorder. The law authorized nurse practitioners, for a five-year period, to become “waivered” to prescribe anti-addiction medications like buprenorphine to prevent opioid withdrawal symptoms.

Previously, this waiver was available only to physicians - yet only around 32,000 of the 800,000 U.S. physicians took advantage of the opportunity to become certified in the 15 years since the drug was approved. As a result, only half of all U.S. counties have a single physician with a license to prescribe buprenorphine, while already - just 18 months after the law’s passage - thousands of NPs have sought out the necessary training to prescribe anti-addiction medication in their communities.

Further strengthening this care net by making the CARA changes permanent has far-reaching potential. Patients, families and communities that now rely on NPs for this critical, stabilizing care need to know that there will be ongoing support for recovery and maintaining sobriety in the years to come.

CARA recognized this trajectory and put forth a plan to better leverage NPs as part of a comprehensive solution. Still, even as the profession steps up to provide the care our communities desperately need, the authorization period is narrowing and practice authority restrictions in 28 states limit the effectiveness of CARA’s vision, oftentimes preventing the most vulnerable patients seeking help for opioid abuse disorder from accessing timely, skilled treatment.

As lawmakers tackle the most difficult and persistent challenges to what has now become the leading cause of death in Americans under the age of 50, better integration of NPs will be a crucial turning point. In the 18 short months since CARA was passed, NPs are helping patients bridge the gap by providing  addiction treatment, moving us all in the right direction. New legislation must build on this trend and capitalize on the proven ability of these capable health care professionals to fight the worst epidemic of this era alongside hundreds of thousands of other trained providers already serving on the front lines. Overdose and addiction have infiltrated virtually every congressional district, and lawmakers are more steadfast than ever in finding solutions that will make a difference. We have no choice but to make changes, and NPs are trained and ready to join the fight.

Joyce Knestrick is the President of the American Association of Nurse Practitioners (AANP) representing over 84,000 NPs across the country.