Expanding access to nurse-managed medication for opioid use disorder

Cos, Travis; Starbird, Laura E.; Lee, Heeyoung; Chun, Bianca; Gonnella, Kristine; Bird, Judith; Livsey, Kae; Bastos, Shelley; O’Brien, Marie; Clark, I.D; Jenkins, Darlene; Tavolaro-Ryley, Laureen

doi:10.1016/j.outlook.2021.03.012

Cited by 7 publications

(8 citation statements)

References 23 publications

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“…Key stakeholders in expanding buprenorphine treatment include the majority of people with OUD who have never received evidence‐based treatment and are more likely to be insured by Medicaid, persons of color, or women of color (Kilaru et al, 2020; Lagisetty et al, 2019). The healthcare workforce, including APRNs, plays an integral role in providing evidence‐based OUD treatment with buprenorphine (Cos et al, 2021). Policymakers can influence and enact significant changes in opioid regulations by creating new standards of care that recognize OUD as a treatable chronic condition deserving of evidence‐based care (Jones & Mason, 2022).…”

Section: Stakeholdersmentioning

confidence: 99%

“…During the COVID‐19 pandemic, psychiatric APRNs in states that suspended practice barriers were six times more likely to report improved clinical practice, possibly attributable to telehealth changes and more efficient prescribing (O'Reilly‐Jacob & Perloff, 2021). Expanding full practice authority for APRNs in all states is paramount to mitigate gaps in OUD treatment and remedy health inequities (Cos et al, 2021; National Academies of Sciences, Engineering, & Medicine, 2021).…”

Section: Policy Solutions and Recommendationsmentioning

confidence: 99%

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Eliminate the buprenorphine DEA X waiver: Justification using a policy analysis approach

Jones

Jacob

Spetz

et al. 2023

J of Nursing Scholarship

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Introduction Drug overdoses have reached a historic milestone of over 100,000 deaths in a single year, 75,673 related to opioids. The acceleration in opioid‐related deaths coupled with stark health inequities demands a close examination of opioid use disorder (OUD) treatment barriers and swift consideration of policy changes. Design The aim of this buprenorphine policy analysis is to summarize existing buprenorphine barriers and present policy solutions to improve access and actualize the contributions of Advanced Practice Registered Nurses (APRNs). Methods The policy analysis follows five sequential steps: (1) defining the problem, (2) identifying key stakeholders, (3) assessing the landscape of relevant policies, (4) describing viable policy options, and (5) making final recommendations. Results Although there are laudable efforts to improve buprenorphine access, such as the new buprenorphine guidelines issued in April 2021, without larger‐scale changes to federal, state, and scope of practice laws, overdose rates will continue to rise. We recommend a multipronged policy approach to improve buprenorphine treatment access, including eliminating the DEA X waiver, improving OUD education, and adopting full practice authority for APRNs in all states. Conclusion Incremental change is no longer sufficient to address opioid overdose deaths. Bolder and coordinated policy action is possible and necessary to empower the full clinical workforce to apply evidence‐based life‐saving treatments for OUD. The critical contributions of nurses in advancing equitable access to OUD care are emphasized in the National Academy of Medicine's Report, Future of Nursing: Charting a Path to Achieve Health Equity. Nurses are named as instrumental in improving buprenorphine access. Policy changes that acknowledge and build on evidence‐based treatment expansion strategies are sorely needed. Clinical Relevance One of the most robust tools to combat opioid overdose deaths is buprenorphine, a partial opioid agonist, and gold standard medication treatment for OUD, but only 5% of the prescribing workforce possess the required Drug Enforcement Agency (DEA) X waiver. A growing body of evidence demonstrates that Advanced Practice Registered Nurses are accelerating the growth in waiver update and buprenorphine use, despite the considerable barriers and limitations described in this policy analysis.

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Section: Stakeholdersmentioning

confidence: 99%

Section: Policy Solutions and Recommendationsmentioning

confidence: 99%

Eliminate the buprenorphine DEA X waiver: Justification using a policy analysis approach

Jones

Jacob

Spetz

et al. 2023

J of Nursing Scholarship

View full text Add to dashboard Cite

show abstract

“…It is projected that, if barriers were removed, NPs and PAs with buprenorphine prescribing ability could increase buprenorphine treatment for patients in rural populations by 15.2% ( Andrilla et al, 2019 ). All 50 states now allow NPs to prescribe buprenorphine either independently or through a relationship with a physician ( Cos et al, 2021 ).…”

Section: Covid-19 and Opioid Morbidity And Mortalitymentioning

confidence: 99%

The NCSBN 2022 Environmental Scan: Resiliency, Achievement, and Public Protection

2022

Journal of Nursing Regulation

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“…Nursing plays an important role in healthcare engagement for PWID. Recent evidence has shown that nurse‐led clinics and the expansion of MOUD address critical gaps in these essential services for PWID, particularly in rural areas (Auty et al, 2020; Barnett et al, 2019; Cos et al, 2021; Klein et al, 2022; Sorrell et al, 2020). Additionally, nurses and nurse case managers working in the primary care setting play a critical role in addressing the holistic care needs of patients, including some barriers identified by this review, and can engage PWID in primary care long term (Beharie et al, 2022; Wason et al, 2021).…”

Section: Clinical Relevancementioning

confidence: 99%

Barriers and facilitators to primary care engagement for people who inject drugs: A systematic review

Heidari

Tormohlen

Dangerfield

et al. 2022

J of Nursing Scholarship

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Introduction People who inject drugs (PWID) have a greater burden of multimorbid chronic diseases than the general population. However, little attention has been paid to the engagement in primary care for services related specifically to injection drug use and management of underlying chronic comorbid diseases for this population. This systematic review identified facilitators and barriers to healthcare engagement in the primary care setting among PWID. Design and Methods Studies were identified by a literature search of PubMed, CINAHL, and EMBASE, and by searching the references of retrieved articles. Studies were included if they measured active injection drug use, and outcomes related to primary care engagement characterized by: diagnosis of a health condition, linkage or retention in care, health condition‐related outcomes, and reported patient–provider relationship. Results Twenty‐three articles were included. Using the behavioral model, factors within predisposing, enabling, need, and health behavior domains were identified. Having co‐located services and a positive patient–provider relationship were among the strongest factors associated with healthcare utilization and engagement while active injection drug use was associated with decreased engagement. Conclusions To our knowledge, this is the only review of evidence that has examined factors related to primary care engagement for people who inject drugs. Most articles were observational studies utilizing descriptive designs. Although the assessment of the evidence was primarily rated ‘Good’, this review identifies a significant need to improve our understanding of primary care engagement for PWID. Future research and intervention strategies should consider these findings to better integrate the holistic care needs of PWID into primary care to reduce morbidity and mortality associated with injection drug use and chronic disease. Clinical relevance Primary care engagement is important for preventative care, early diagnosis of disease, and management of chronic diseases, including addressing problems of substance use. This review highlights factors nurses can utilize to facilitate primary care engagement of PWID.

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Expanding access to nurse-managed medication for opioid use disorder

Cited by 7 publications

References 23 publications

Eliminate the buprenorphine DEA X waiver: Justification using a policy analysis approach

Eliminate the buprenorphine DEA X waiver: Justification using a policy analysis approach

The NCSBN 2022 Environmental Scan: Resiliency, Achievement, and Public Protection

Barriers and facilitators to primary care engagement for people who inject drugs: A systematic review

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