States Should Look to Nurse Practitioners to Fight Against Opioid Epidemic

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COMMENTARY | Nurse practitioners can help fill provider shortages and provide treatment to individuals addicted to opioids.

Last year, approximately 72,000 Americans died from a drug overdose. More than two-thirds of those deaths were related to opioid use disorder, an epidemic that has left states struggling to make headway in a crisis that overwhelmed many of the public services they provide.

Primary health care providers are on the front lines of the fight against opioid use disorder—deploying treatment plans like “Medication-Assisted Treatment” or MAT, which use medications to prevent overdoses and reduce drug cravings, combined with counseling and therapy. These plans are proving to be effective—a bright spot in the health care profession’s war on the opioid epidemic.

However, many of those addicted to opioids do not have adequate access to primary health care providers. In fact, 80% of Americans with opioid use disorder are not receiving treatment right now.

Why not? A key factor is the severe shortage of primary care providers across the United States. According to the U.S. Department of Health and Human Services (HHS), nearly 80 million Americans lack access to adequate primary health care, and shortages are much worse in rural areas compared to suburban and urban areas.  

States can act to alleviate these provider shortages—which are on track to significantly worsen in the coming years—by modernizing their utilization of nurse practitioners (NPs) so that they can more fully assist in the treatment of people with opioid use disorder.

There are more than 270,000 licensed nurse practitioners, or NPs, in the United States. NPs are highly skilled professionals, having started their careers as registered nurses and completing masters or doctoral degree programs for advanced clinical education followed by earning national board certification in specific clinical focus areas.

NPs are qualified in all 50 states to assess patients, order and interpret diagnostic tests, develop treatment plans and prescribe medications. NPs practice under the laws of the state in which they are licensed, providing health care services in rural and urban areas—and most importantly, more than three-quarters of NPs are trained in providing primary care.

Despite these notable credentials, NPs do not have full practice authority in 28 states. That means NPs are restricted in their ability to practice without extensive supervision and management by a physician for activities they are already well-trained to perform, such as prescribing medications to treat opioid use disorder and other illnesses. In some states, NPs are required to sign complex agreements with physicians, which limit how and where NPs can practice. This can vastly limit or disrupt care in rural areas, when these types of agreements may require NPs to practice within a specified number of miles from their supervising physician. Ultimately, this reduces access to health care for patients, especially in rural areas suffering from opioid use disorder.

This does not have to be the case. All NPs can complete training, provided by various organizations, including the American Association of Nurse Practitioners, and apply for a Drug Enforcement Administration waiver to provide MATs. NPs in the 22 states and Washington, D.C. that grant full practice authority have the ability to administer MATs once they receive that waiver, providing patients with opioid use disorder with greater access to treatment. For NPs in the remaining 28 states, this is a missed opportunity to address treatment shortages as even with the federal waiver they cannot prescribe MATs without collaboration or supervision from a waiver-eligible physician. Additionally, NPs in those states often find it difficult to find a physician who meets the criteria further restricting their ability to administer effective treatments.

Modernization of these state laws and regulations would empower NPs to do more to treat opioid use disorder and offer greater access to treatment for patients in need. While 11,000 NPs across the county have completed MAT training in the last 3 years and are authorized by the DEA to prescribe MAT for their patients, states that restrict NP practice are more limited in expanding access to substance use disorder treatment. 

State policymakers must look closely at the facts. The primary care physician workforce is shrinking. By 2030, it is estimated that we will face shortages of more than 120,000 primary care physicians needed to address patient demand. Meanwhile, the NP primary care workforce is growing, with 26,000 new NPs completing academic programs in 2017-2018. According to a recent report, the number of NPs in the workforce between 2016-2030 is expected to grow by 6.8 percent annually, and they will be far more likely to practice in rural and underserved areas.

NPs are key allies in the fight against the epidemic of opioid use disorder. To address the rising tide of Americans needing treatment, states must remove barriers that keep NPs from doing their jobs and providing life-saving care. NPs are uniquely qualified to provide high-quality, comprehensive and cost-effective primary health care to all patients, especially those who need our help the most.

Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, is a licensed nurse practitioner in the state of Louisiana and the President of the American Association of Nurse Practitioners (AANP).

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