Volume 23, Issue 1 , Pages 92-93, January 2012
Advanced Practice Nurse Prescriptive Authority of Buprenorphine:
Adopted by the ANAC Board of Directors September 17, 2011
Article Outline
Position
It is the position of Association of Nurses in AIDS Care that:
Problem Statement
According to the Drug Addiction Treatment Act of 2000, only “qualified physicians” may prescribe Schedule III, IV or V medications for opioid treatment, including buprenorphine (SAMHSA, n.d.). This provision limits the number of available providers and restricts patient access to care.
Advanced practice registered nurses (APRNs), including Nurse Practitioners (NPs) and Clinical Nurse Specialists (CNSs) provide safe, quality and cost-effective care. APRNs possess advanced education that enables them to diagnose and prescribe medications in their areas of specialization. According to the American Academy of Nurse Practitioners (AANP), “Restrictions on prescriptive authority limit the ability of nurse practitioners to provide comprehensive health services” (AANP, 2010, ¶ 3).
Studies have demonstrated that patients report high levels of satisfaction with care provided by nurses with prescriptive authority (Drennan et al., 2011) and nurse care management models have been implemented to expand availability of opioid treatment services (Pond, 2009). Granting buprenorphine prescriptive privileges to qualified advanced practice nurses falls well within their scope of practice and would result in expanded patient access to care.
Background
Buprenorphine was approved by the Food and Drug Administration in 2002 to offer treatment for opioid addiction by alleviating drug cravings and lessening withdrawal symptoms. An advantage of buprenorphine is that patients can seek treatment in their own primary care provider’s office or clinic. The availability of buprenorphine expanded patient access to treatment, and offered an important opportunity for providers to manage both HIV and drug treatment in one setting. In fact, Sullivan et al. (2006) demonstrated that the integration of HIV care and opioid dependence treatment proved beneficial for treatment retention and reductions in substance use.
Waivers to prescribe buprenorphine have been restricted to physicians who meet specific qualifications (SAMHSA, n.d.). The number of patients who would benefit from a treatment plan that includes buprenorphine far exceeds the number of available providers. According to the International Nurses Society on Addictions (2011), “This disparity could be lessened, and access to quality addictions treatment enhanced, by expanding the field of potential buprenorphine prescribers to include Advanced Practice Registered Nurses” (pp. 1–2).
Roose, Kunins, Sohler, Elam, and Cunningham (2008) found that NPs who care for people living with HIV have expressed a high interest in prescribing buprenorphine. This same study also determined that NPs were equally as interested in prescriptive authority as generalist physicians, and were more interested than infectious disease physicians.
Advanced practice nurses are regulated by state boards of nursing or other designated state agencies, entities which monitor and facilitate competent clinical practice. Nurse practitioners can prescribe other controlled substances in most states (United States Department of Justice, 2011). ANAC recommends, therefore, that APRNs seeking prescriptive authority for buprenorphine must hold a current State nursing license and a Drug Enforcement Administration Controlled Substance Registration Certificate. Standards to maintain prescriptive privileges can be consistent with those required for authorized physicians.
References
- American Academy of Nurse Practitioners. (2010). Position statement on nurse practitioner prescriptive privilege. Retrieved from http://www.aanp.org/NR/rdonlyres/CFCFB108-1215-4BCF-93B2-1174CA9C4413/0/2010Prescriptive.pdf
- Patients’ level of satisfaction and self-reports of intention to comply following consultation with nurses and midwives with prescriptive authority: A cross-sectional survey. International Journal of Nursing Studies. 2011;48(7):808–817
- International Nurses Society on Addictions. (2011). The prescribing of buprenorphine by advanced practice addictions nurses. Retrieved from http://www.intnsa.org/publications/documents/BuprenorphinePositionPaperFINAL6-30-11.pdf
- Pond, M. H. (2009). Buprenorphine treatment: A nurse’s story. Retrieved from http://www.samhsa.gov/samhsanewsletter/Volume_17_Number_3/NurseManagersStory.aspx
- . Nurse practitioner and physician assistant interest in prescribing buprenorphine. Journal of Substance Abuse Treatment. 2008;34(4):456–459
- A trial of integrated buprenorphine/naloxone and HIV clinical care. Clinical Infectious Diseases. 2006;43(Suppl. 4):S184–S190
- Substance Abuse and Mental Health Services Administration. (n.d.). Buprenorphine: Drug Addiction Treatment Act of 2000. Retrieved from http://buprenorphine.samhsa.gov/fulllaw.html
- United States Department of Justice. (2011, Feb 10). Mid-level practitioners authorizations by state. Retrieved from http://www.deadiversion.usdoj.gov/drugreg/practioners/mlp_by_state.pdf
PII: S1055-3290(11)00248-2
doi:10.1016/j.jana.2011.12.004
© 2012 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
Volume 23, Issue 1 , Pages 92-93, January 2012
