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Authors

  1. Kaplan, Louise PhD, ARNP, FNP-BC, FAANP, FAAN

Article Content

The United States is experiencing an opioid epidemic. In 2013, prescription opioids accounted for 18,893 deaths-a 3.4-fold increase from 2001.1 Deaths from heroin increased sixfold from 1,466 deaths in 2001 to 10,574 deaths in 2014.1

 

Numerous efforts are underway toprevent these deaths; however, NPs cannot participate in one strategy: office-based treatment of opioid addiction using buprenorphine-based medications. The Drug Addiction Treatment Act (DATA) of 2000 excludes NPs from this practice.2 Momentum is growing to amend DATA through the Recovery Enhancement for Addiction Treatment Act, referred to as the "TREAT Act" (H.R. 2536/S. 1455) or the Heroin andPrescription Drug Abuse Prevention and Reduction Act (H.R. 4396/S. 2562).3-6 Both acts would authorize NPs to prescribe buprenorphine-based medications to patients with opioid addiction.3-6

 

DATA permits licensed physicians with Drug Enforcement Administration registration who meet certain conditions to obtain a waiver from the separate registration requirements of the Narcotic Addict Treatment Act of 1974 to treat opioid addiction.7 These physicians may prescribe and dispense FDA-approved controlled substances for addiction. The physicians must also attest to being able to refer patients to counseling and other nonpharmacologic therapies. No more than 30 patients with addiction may be cared for at one time unless notification is given after the initial year to increase to 100 patients.2

 

Both the TREAT Act and the Heroin and Prescription Drug Abuse Prevention and Reduction Act would increase the number of patients treated by a qualifying practitioner in the first year from 30 to 100. After 1 year, the practitioner may submit notification to treat an unlimited number of patients (except in the House version of the TREAT Act). More importantly, the bills revise the definition of "qualifying practitioner" to include NPs who meet certain criteria.3-6

 

Qualifications

The House of Representatives versionof the TREAT Act has language potentially more restrictive than the other bills with wording suggesting that NPs-even in full-practice authority states-would require physician collaboration. The other bills clearly state that the NP complies with requirements for collaboration or supervision (only if required under state law).3-6 The bills require an NP to have at least 24 hours of approved education regarding treatment and management of opioid-dependent patients for substance abuse disorder. The NP will also demonstrate the ability to treat and manage opioid-dependent patients.3-6 The NP must practice in a designated, qualified practice setting.

 

Preventing opioid addiction

Both sponsors of the TREAT Act inthe House and Senate are Democrats. Only 6 of the 26 co-sponsors inthe House of Representatives are Republican. Only 3 of the 20 co-sponsors in the Senate are Republican.3,4 The Heroin and Prescription Drug Abuse Prevention and Reduction Act has 33 co-sponsors in the House of Representatives of which none are Republican; the Senate version only has one Democratic co-sponsor.5,6 As both the House and Senate are controlled by Republicans, it is imperative to obtain additional Republican sponsors for the legislation to receive consideration.

 

Prevention of opioid addiction isa top priority and a long-term strategy for which all NPs should advocate. Contact your members ofCongress to co-sponsor and/or support the bill.

 

REFERENCES

 

1. National Institute on Drug Abuse. Overdose death rates. 2015. http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates. [Context Link]

 

2. Substance Abuse and Mental Health Services Administration. Drug Addiction Treatment Act of2000. http://buprenorphine.samhsa.gov/titlexxxv.html. [Context Link]

 

3. H.R. 2536 Recovery Enhancement for Addiction Treatment Act. http://www.congress.gov/bill/114th-congress/house-bill/2536/text. [Context Link]

 

4. S1455 Recovery Enhancement for Addiction Treatment Act. http://www.congress.gov/bill/114th-congress/senate-bill/1455/text. [Context Link]

 

5. H.R. 4396 Heroin and Prescription Drug Abuse Prevention and Reduction Act. http://www.congress.gov/bill/114th-congress/house-bill/4396/text. [Context Link]

 

6. S. 2562 Heroin and Prescription Drug Abuse Prevention and Reduction Act. http://www.congress.gov/bill/114th-congress/senate-bill/2562/related-bills. [Context Link]

 

7. Narcotic Addict Treatment Act of 1974. http://www.gpo.gov/fdsys/pkg/STATUTE-88/pdf/STATUTE-88-Pg124.pdf. [Context Link]