Monday, April 24, 2017

Nurse practitioners join fight against opioid addictions by gaining ability to prescribe anti-addiction medication

Rural America is struggling with an opioid epidemic. Since 1999, opioid overdoses cause four times more deaths in America. In 2015, nearly 13,000 people died from heroin overdoses which were 20,6% more than in 2014. Although all states have experienced increases in opioid overdoses, states with large rural populations, like Kentucky, West Virginia, Alaska, and Oklahoma, have experienced disproportionately high increases. Various blog posts have recently discussed this issue (here, here, here, and here).

Unfortunately, there is a shortage of doctors in rural areas to treat this problem. In rural areas, the patient-to-primary care physician ratio is 39.8 physicians per 100,000 people. In urban areas, the ratio is 53.3 per 100,000 people. This shortage will only worsen after the United States Citizenship and Immigration Services made procedural changes to the temporary visas for skilled workers (H-1B visas) because rural areas depend heavily on foreign doctors. 

However, nurse practitioners may help to solve the shortage of doctors in rural areas. In 2012, 127,000 nurse practitioners provided patient care in the United States. Nurse practitioners are registered nurses who have also completed Master's degrees or other higher level nursing degrees. It takes much less time to become a nurse practitioner rather than a physician with an M.D. On average it takes six years of education and training to become a nurse practitioner and eleven to twelve years for a physician to complete their education and residency. Like physicians, nurse practitioners can hold hospital privileges, write prescriptions, specialize in certain practice ares. 

There are already significantly more nurse practitioners practicing in rural areas than physicians. There are 85.3 registered nurses per 10,000 rural residents compared to 13.1 physicians and surgeons per 10,000 rural residents. However, in many states, nurse practitioners cannot prescribe life-saving medication to opioid addicts.

This month two federal agencies gave over 700 nurse practitioners the ability to write prescriptions for buprenorphine to create broader access to the anti-addiction medication. In the United States, a federal licenses is required to prescribe buprenorphine. Buprenorphine is one of three anti-addiction medications approved by the FDA. It is a highly effective addiction treatment because it prevents withdrawal system and lessens cravings. The Comprehensive Addiction Treatment and Recovery Act passed in 2016 allows nurse practitioners and physician assistants to obtain federal licenses to prescribe buprenorphine. To obtain the license nurse practitioners must complete a 24-hour training and may only prescribe it to 30 patients a year. (Qualifying physicians may currently prescribe it to 275 patients a year).

Currently 28 states restrict nurse practioners' scope of practice by only letting them prescibe buprenorphine if they are working in collaboration with a doctor who has a federal license to prescribe it. However, 21.2 million people live in rural counties with no physician with a waiver for office-based physicians to prescribe buprenorphine. Of the total counties in the United States with no physician able to prescribe buprenorphine, 82.1% were in rural areas. In addition, Oklahoma, Tennessee, and Wyoming explicitly prohibit Nurse Practitioners from prescribing buprenorphine even if they are working with a licensed physician. 

Credit: Huffington Post

Some states recognize the potential positive impacts allowing nurse practitioenrs to prescribe buprenorphine. Oregon is currently updating its laws to allow nurse practitioners to prescribe buprenorphine for addiction. Currently nurse practitioners can prescribe Schedule III drugs like buprenorphine for pain management, but not for addiction treatment. In 2016, West Virgina changed its laws to allow nurse practitioners to prescribe all prescription drugs except Schedule II drugs (i.e., Percocet,  Vicadin, and OxyContin) without doctor supervision. West Virginia has a large rural population, a shortage of medical professionals, and the most overdose deaths in the country.

Hopefully, more states will follow Oregon and West Virginia's example and change their laws to allow nurse practitioners to prescribe buprenorphine. With the physician shortage and rise of opioid overdoses, rural areas can benefit from more medical professions having the ability to prescribe buprenorphine to treat addiction.

1 comment:

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