Midlevel practitioners authorized to prescribe buprenorphine

The Department of Health and Human Services (HHS) announced a new 2017 policy that will allow physician assistants (PAs) and nurse practitioners (NPs) to prescribe buprenorphine. Previously, only physicians were authorized to prescribe the medication.

Many believe the decision makes sense because these practitioners are already permitted to prescribe a limited list of medications in everyday practice, such as antibiotics, for example, and buprenorphine will be a critical addition to the armamentarium. Also, advocates point out that more buprenorphine prescribers are needed to meet the demand for addiction treatment services.

“Many NPs currently work in practice settings where they care for patients with addiction, however prior to this new authorization, they were not able to fully manage this patient population,” says Anne Norman, DNP, APRN, FNP-C, FAANP, vice president of education for the American Association of Nurse Practitioners.

Norman says according to the association’s latest numbers, there are 222,000 practicing NPs in the United States who deliver direct care to patients with chronic conditions, including substance use disorders. The NP community has an interest in expanding its scope under the new policy.

Further reach

In all cases, the medical professionals must complete training—eight hours of education for physicians and 24 hours for PAs and NPs—and apply for a federal waiver. According to HHS, training will be available either at no cost through a SAMHSA-funded program or through training programs through various professional societies.

Physicians may treat up to 275 patients. NPs and PAs, however, are only authorized to prescribe buprenorphine for a maximum of 30 patients.

“HHS has communicated their intent to initiate rulemaking that would allow NPs and PAs who have prescribed for the maximum number of 30 patients for one year to apply for a waiver to prescribe buprenorphine for up to 100 patients,” Norman says. “We believe there will be a percentage of NPs that will pursue this process.”

This is the second move by HHS to help increase use of medication-assisted treatment. In July, new rules expanded the maximum number of patients that prescribing physicians may treat with buprenorphine from 100 to 275. As of early November, an overall total of 32,421 physicians are waivered to prescribe buprenorphine, and according to the department, 2,477 have been granted a waiver at the 275-patient limit.

Even so, industry leaders caution that buprenorphine must always be part of a treatment plan that includes counseling and recovery support.