TREAT ACT (RECOVERY ENHANCEMENT FOR ADDCITION TREATMENT ACT)
It is my sincere hope that, by the time this column is published in our journal, this legislation will have passed both houses and has been signed by the President of the United States. If that is the case, then I applaud and thank all of those nurses who have written to their legislative representatives in support of this legislation.
Having knowledge of the legislative process in the United States, I doubt that this will be the case. If the latter is true, then the information in this column is timely and relevant and requires your action.
It is a well-known fact that the prescription opioid epidemic and the abuse of heroin continue to negatively impact individual lives on a daily basis. Many states have enacted legislation in an effort to combat this growing epidemic. One example is the State of New Jersey, where all prescriber's prescriptions are embedded with various codes so that, if a client alters a prescription, it would be readily identifiable by the pharmacist.
It is a well-known fact that abuse of opioids, especially with intravenous administration and the sharing of needles, can lead to other illnesses, for example, the transmission of Human Immunodeficiency Virus (HIV) and viral hepatitis. Other negative consequences include social harms such as criminal activity.
It is also well known that there are a limited number of physician providers to treat such patients. Roughly half of the patients diagnosed with such disorders in 2012 did not have access to medication-assisted treatment facilities. Other providers such as nurse practitioners and physician assistants, who prescribe controlled substances in their respective states and have the proper credentials and training in substance use disorders, could assist in drastically reducing this raging epidemic.
On July 23, 2014, Senator Edward J. Markey (D-Massachusetts) introduced the Recovery Enhancement for Addiction Treatment (TREAT) Act.
This bill will increase the number of patients that qualified physicians could treat for opioid dependency and, for the first time, allow certain nurse practitioners and physician assistants to treat patients with substance use disorders by providing access to medication-assisted treatments such as the prescribing of buprenorphine. Combining medication-assisted treatment with behavioral therapy for opioid dependency can decrease overdose deaths; can reduce transmissions of HIV and viral hepatitis, criminal activity, and other social harms; and can also be cost-effective. This bill lifts existing federal restrictions that limit access to lifesaving therapies, while emphasizing addiction specialty expertise and quality.
This bill amends the Controlled Substances Act to increase the number of patients that a qualifying practitioner dispensing narcotic drugs for maintenance or detoxification treatment is initially allowed to treat from 30 to 100 patients per year.
This bill will permit qualifying physicians, after 1 year, request approval to treat an unlimited number of patients under specified conditions. Physicians must be substance abuse treatment specialists, as recognized by specific board or society certifications, or nonspecialist physicians must complete approved training and practice in a qualified practice setting. Physicians must also meet the following criteria:
1. agree to fully participate in the Prescription Drug Monitoring Program of the state in which the physician is licensed;
2. practice in a qualified practice setting; and
3. have completed at least 24 hours of training regarding treatment and management of opiate-dependent patients for substance use disorders provided by specified organizations.
This bill redefines what a "qualifying practitioner" is:
1. a physician who holds a board certification from the American Board of Addiction Medicine; and
2. a nurse practitioner or physician's assistant, who is licensed under state law to prescribe Schedule 3, 4, or 5 medications for pain and who
a. has specified training or experience that shows specialization in the ability to treat opiate-dependent patients; and
b. is supervised by a physician who is approved to prescribe opioid addiction therapy or is a certified addiction treatment nurse practitioner who practices in collaboration with such a physician in a qualified practice setting, where allowable by state law.
"Qualified practice settings" are defined in the legislation and include clinical settings that have specified oversight and performance metrics/quality review or are part of systems serving populations with high need.
This bill also directs the Comptroller General to initiate an evaluation of the effectiveness of this Act, including an evaluation of the following:
1. changes in the availability and use of medication-assisted treatment for opioid addiction;
2. the quality of medication-assisted treatment programs;
3. integration with routine health services;
4. diversion of opioid addiction treatment medication;
5. changes in state or local policies and legislation relating to opioid addiction treatment; and
6. use of nurse practitioner and physician's assistant prescribers.
This legislation is endorsed by the American Medical Association, the American Society of Addictions Medicine, and the American Association of Nurse Practitioners, to name a few.
The International Nurses Society on Addictions completely supports this legislation. The International Nurses Society on Addictions approved a position paper in 2011 on the prescribing of buprenorphine and recommended in this paper that nurse practitioners must have achieved certification as a certified addictions registered nurse-advanced practice.
On May 21, 2015, the TREAT Act was introduced to the House by Representative Brian Higgins (D-NY) and Co-sponsor Representatives Richard L. Hanna (R-NY), Paul Tonko (D-NY), and John Katko (R-NY).
The bill currently is in the House Committee on Energy and Commerce and, in addition, is in the House Committee on the Judiciary.
Now is the time for all International Nurses Society on Addictions (IntNSA) members and their colleagues to utilize a grassroots effort in notifying their respective legislators in their states to approve and move this legislation forward so that this ACT becomes a reality!
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