1. Cotton, Brandi Parker PhD, PMHNP-BC
  2. Ferszt, Ginette G. PhD, PMHCNS-BC, FAAN

Article Content

National Opioid Awareness Week is May 13-19, 2018. Although the focus of activities is on prevention, decreasing stigma and educating the public about treatment in primary care practices is essential. Approximately 115 people die every day from opioid overdose, and the number continues to rise.1 This serious, escalating public health crisis has led to medication-assisted treatment for opioid use disorders in both specialty and primary care practices. As healthcare providers, legislatures and public health programs strive to decrease drug-related fatalities; nursing can play a significant role in confronting this crisis.


NPs to the rescue

NPs are ideally positioned to make a major impact on decreasing opioid overdose in primary care and specialty practices. Treatment with buprenorphine is associated with decreased illegal opioid use and related fatalities.2 Yet, the prescribing of buprenorphine is restricted by laws, limiting the number of patients allowed per provider.


Presently, prescribers must apply for a waiver to prescribe buprenorphine and may treat a maximum of 30 patients the first year, increasing to 100 patients the second year.3 Physicians with waivers to prescribe buprenorphine do so for far fewer patients than the waivers allow.4 As such, more providers are needed to meet the increasing demand. With a modest time commitment of just 24 hours of free online training, NPs could easily fill this gap.


Barriers to prescribing

Despite cost-free training, the number of NPs who maintain waivers to prescribe is still small. In 2017, slightly less than 2,500 certified NPs were prescribing buprenorphine, with this number varying broadly by state.5 Legislation that restricts prescriptive authority for NPs to obtain waivers is a definitive barrier. For example, several states explicitly prohibit NPs from prescribing buprenorphine under any condition, and more than half of all states require direct collaboration with a waivered physician.


Prescribing buprenorphine requires additional training and monitoring, given the risk of diversion and potential concomitant use of illegal opioids. Providers identify a lack of education and mentorship in addiction services as a barrier.4 Finally, cultural stigma persists despite the increasing rise of substance use disorders across all age, ethnicity, and socioeconomic demographics.


Addressing the shortage of trained providers

A number of strategies must be employed to address the above factors that contribute to the shortage of trained providers. First, increasing outreach and education to NPs regarding the importance of buprenorphine is critical. Second, legislative initiatives to expand prescriptive authority for NPs across the United States are needed to address the national shortage of buprenorphine prescribers-especially in rural areas.


Finally, service care delivery models must include education and support in the management of opioid use disorders by nonspecialist providers. With this approach, NPs will be educated, trained, and ideally positioned to assist in the national effort to address the opioid epidemic in the United States.




1. Centers for Disease Control and Prevention/NCHS, National Vital Statistics System, Mortality. CDC Wonder, Atlanta, GA: US Department of Health and Human Services, CDC; 2017. [Context Link]


2. Ling W, Wesson DR. Clinical efficacy of buprenorphine: comparisons to methadone and placebo. Drug Alcohol Depend. 2003;70(2 suppl):S49-S57. [Context Link]


3. Substance Abuse and Mental Health Services Administration. Buprenorphine Waiver Management. 2018. [Context Link]


4. Stein BD, Sorbero M, Dick AW, Pacula RL, Burns RM, Gordon AJ. Physician capacity to treat opioid use disorder with buprenorphine-assisted treatment. JAMA. 2016;316(11):1211-1212. [Context Link]


5. National Council on Alcoholism and Drug Dependence. Increasing Availability of Medication-Assisted Treatment Using Buprenorphine. 2017. [Context Link]