PAs to Play Role in Solving Opioid Epidemic

Everyone who works in medicine is painfully aware of the opioid epidemic that is growing in the United States. Working in surgery, and in a hospital based environment, I work with pain management and pain control every day.

According to the U.S. Centers for Disease Control and Prevention, overdose deaths involving prescription opioids have quadrupled since 1999. Each day, 44 people in the U.S. die from overdose of prescription drugs, and a large portion of these overdoses result from opioids.

This is a serious public health problem that requires a coordinated and comprehensive response from providers, the government, the  public, and healthcare facilities. Physician assistants (PAs) and Nurse Practitioners (NPs) will soon be added to provider teams who have the full array of options available to treat opioid dependency.

Over the past year, AAPA aggressively lobbied for PAs to be part of the solution to the nation’s opioid epidemic. As a result of AAPA’s efforts, PAs will soon be eligible to become waivered to prescribe buprenorphine for the treatment of opioid addiction. On July 8, the U.S. House of Representatives overwhelmingly supported passage of the House-Senate Conference report to S. 524, the Comprehensive Addiction and Recovery Act (CARA) of 2016 and the U.S. Senate followed suit on July 13. The legislation amends federal law (the Drug Addiction Treatment Act of 2000 or DATA 2000) to permit PAs to become waivered to prescribe buprenorphine for the treatment of opioid addiction.  It will now be sent to President Obama for his expected signature.

The final version of the Medication-Assisted Treatment program includes the following:

• Authorizes PAs and NPs to become waivered to prescribe buprenorphine in MAT for a five-year period, expiring in 2021;

• Allows newly-waivered PAs, NPs, and physicians to prescribe buprenorphine to 30 patients, with the option to treat up to 100 patients after one year if certain conditions are met;

Requires PAs and NPs to obtain 24 hours in education related to the treatment of opioid addiction as a condition to be waivered; the law includes AAPA in the list of professional associations who may provide the educational requirements; additionally, the law provides the secretary of the Department of Health and Human Services (HHS) the flexibility to adjust the 24-hour educational requirement for clinicians with demonstrated experience in treating patients struggling with addiction;

• Defers to state law regarding whether a PA or NP works with a physician through a supervisory or collaborative relationship; however, the legislation requires that a physician who supervises or collaborates with a PA or NP must also be waivered to prescribe buprenorphine to treat addiction; given the small number of waivered-physicians, particularly in rural and other medically underserved communities, there is concerned this requirement will limit the number of PAs and NPs who will become waivered; fortunately, there is also a provision in the bill that provides flexibility to the HHS Secretary to review and remove the requirement.

In addition to MAT, CARA contains numerous programs and provisions designed to:

• Support and provide grants for education, prevention, treatment, and recovery efforts to confront the opioid epidemic and assist individuals and communities suffering from addiction to opioids and heroin;

• Provide grants to expand access to naloxone and prescription drug monitoring programs and to support veterans and law enforcement.

Treatment of the opioid epidemic in America requires and “all hands on deck” response. It also requires a coordinated response that requires medical treatment, counseling, education and prevention. The more than 108,500 PAs in clinical practice across the nation represent a ready, willing and able human resource to assist in the effective treatment of this epidemic, and be a large part of the solution to the problem of opioid abuse in the U.S.