Perspectives on APRN prescribing of medications for opioid use disorder: Key barriers remain.

Autor: Chapman SA; University of California San Francisco School of Nursing, Department of Social and Behavioral Sciences, 490 Illinois Street, 12th Floor, San Francisco, CA 94143, United States of America. Electronic address: susan.chapman@ucsf.edu., Fraimow-Wong L; UCSF School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, United States of America. Electronic address: leah.fraimow-wong@ucsf.edu., Phoenix BJ; University of California San Francisco School of Nursing, Department of Community Health Systems, 2 Koret Way, 5th Floor, San Francisco, CA 94143-0608, United States of America. Electronic address: beth.phoenix@ucsf.edu., Tierney M; University of California San Francisco School of Nursing, Department of Community Health Systems, 2 Koret Way, 5th Floor, San Francisco, CA 94143-0608, United States of America. Electronic address: matt.tierney@ucsf.edu., Spetz J; Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco, 490 Illinois Street, 7th Floor, San Francisco, CA 94158, United States of America. Electronic address: joanne.spetz@ucsf.edu.
Jazyk: angličtina
Zdroj: Journal of substance use and addiction treatment [J Subst Use Addict Treat] 2024 Feb; Vol. 157, pp. 209215. Date of Electronic Publication: 2023 Nov 18.
DOI: 10.1016/j.josat.2023.209215
Abstrakt: Introduction: Deaths from drug overdoses are rising dramatically in the United States. Treatment for opioid use disorders may include behavioral treatments as well as medications for opioid use disorders (MOUD). Buprenorphine can be prescribed by physicians, nurse practitioners (NPs), other advanced practice registered nurses (APRNs), and physician assistants (PAs) and required a training and a federal waiver until recently. The number of NP MOUD prescribers grew steadily over the past decade, but research has identified state-level scope of practice regulations as a barrier to NP MOUD prescribing. This article explores the contributions of, and remaining barriers faced by NP and other APRN MOUD prescribers. We describe qualitative findings from a study of NPs and other key stakeholders involved in MOUD treatment in four states with two differing levels of regulatory structure.
Methods: In this qualitative study, we conducted site visits and semi-structured interviews with NPs and other APRNs, physicians, clinic managers, and regulators in four states including New Mexico and West Virginia (full practice authority for NPs), and Ohio and Michigan (which require physician supervision). Interview notes were entered into a qualitative software package and coded and reviewed by two members of the research team. Data were grouped into key themes.
Results: A total of 76 participants participated in individual or small group interviews in the four states. We found key themes and several subthemes that describe NP practice in MOUD. Participants described key contributions of NP engagement in MOUD, including increasing access, serving rural areas, the unique role of psychiatric NPs, and the value of the nursing model of care in working with people with substance use disorders (SUD). Participants also identified barriers including scope of practice regulations, other regulatory barriers, stigma, and lack of supportive services to address psychosocial needs.
Conclusions: The waiver requirements were eliminated at the end of 2022 in federal budget legislation. Other barriers for NP and other APRN prescribers remain and should be addressed in practice, and in state and federal regulations. Research needs to explore the impact of the waiver elimination on MOUD prescribing and access to services.
(Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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