Empowering Psychiatric Mental Health Nurse Practitioners to Expand Treatment Opportunities for Veterans With Opioid Use Disorder

Abstract

Background Few veterans with opioid use disorder receive effective treatment despite the Veterans Health Administration's efforts to expand treatment by offering buprenorphine, a medication to treat opioid use disorder (MOUD). An insufficient prescribing workforce contributes to the underutilization of buprenorphine; however, nurse practitioners (NPs) can now obtain a waiver to prescribe this medication. This quality improvement project aimed to expand the prescribing workforce by educating psychiatric mental health NPs (PMHNPs) working in an emergency setting at a Veterans Affairs Health Care System about free MOUD training and empowering them to utilize buprenorphine treatment. Methods Eleven PMHNPs were asked for their perception of prescribing buprenorphine. They were asked if they had an MOUD waiver and/or were aware of the free waiver training. The PMHNPs were educated on the importance and process of obtaining the DEA-X waiver, and then a post-intervention discussion was completed to determine if they completed the waiver training. Results At baseline, all 11 PMHNPs believed offering MOUD was important, but only three had the waiver to prescribe buprenorphine. After the education, three additional PMHNPs obtained the waiver and 10 planned to have the waiver in the next year. The department is planning to trial offering buprenorphine treatment, and PMHNPs at this facility are privileged to prescribe buprenorphine. In addition, five new PMHNP residents started or completed the training. Conclusions This project shows the potential to increase veteran access to MOUD by emphasizing education and empowering PMHNPs to initiate treatment. Providing education regarding the importance of buprenorphine treatment in the emergency setting and delivering information about the free waiver training facilitated workforce preparedness.

Health Professionals’ Attitudes toward Medications for Opioid use Disorder

“…Studies have found that non-physician prescribers (nurse practitioners and physician assistants) are at least as likely to be interested in providing buprenorphine compared to generalist physicians, 71 , 97 although more efforts may be needed to increase their awareness of the waiver process 102 . Recent studies have focused on the initiation of buprenorphine in emergency departments (ED), and have found that most prescribers working in these settings are supportive of ED-initiated buprenorphine 97 , 102 , 109 …”

“…Recent studies have examined the effects of various organizational and educational interventions related to the adoption of buprenorphine treatment among prescribers 96 , 102 , 104 – 106 , 108 . Receipt of buprenorphine-specific training is associated with increases in knowledge, positive attitudes about buprenorphine's effectiveness, and intending to or obtaining a DATA waiver 83 , 86 , 106 , 108 .…”

“…61,64,72,83,94 Recent studies have shown that physicians with less tenure tend to have more positive attitudes toward MOUD including buprenorphine and are more likely to express interest in obtaining a DATA waiver compared to more established physicians. 97,103,107,109,110 Studies have found that non-physician prescribers (nurse practitioners and physician assistants) are at least as likely to be interested in providing buprenorphine compared to generalist physicians, 71,97 although more efforts may be needed to increase their awareness of the waiver process. 102 Recent studies have focused on the initiation of buprenorphine in emergency departments (ED), and have found that most prescribers working in these settings are supportive of ED-initiated buprenorphine.…”

Integration of medication for opioid use disorder training into graduate nursing education

“…By including this pharmacology‐based training in our broader course content that included topic areas such as racism, LGBTQ health, veteran's health, violence and poverty, we allowed for a more complete and nuanced context for students to examine the complexity of these MOUD treatment including the precipitating structural contributing factors. Others have focused MOUD training for Psychiatry Mental Health APRN students only 21 despite recent recommendations for screening for substance use disorder in all settings where patient care to adults is provided 22…”

Roles and Perceptions of Nurses During Implementation of a Medication Treatment for Opioid Use Disorder National Initiative

“…In several states, advanced practice registered nurses may prescribe MOUD, which has improved access to MOUD, particularly in rural areas (Andrilla et al, 2020; Barnett et al, 2019; Cos et al, 2021; Cotton & Ferszt, 2018; Fornili & Fogger, 2017; Jones et al, 2020; Klein et al, 2022; Lee & McNeely, 2019; Nguyen et al, 2021; Rowe et al, 2022; Saunders et al, 2021; Spetz et al, 2019; Tierney et al, 2015). However, registered nurses, or nurse care managers, can also provide MOUD care through a collaborative care model (CCM) where nurses assume a coordinator role (Alford et al, 2011; LaBelle et al, 2016).…”