Empowering Nurse Practitioners Could Help Solve The US Opioid Crisis

America’s crippling opioid overdose crisis requires all hands on deck to help save lives. 

The situation is critical, and statistics help tell why the outlook is grim.

An estimated 130-plus people die in the U.S. die daily from opioid overdoses, according to the National Institute on Drug Abuse (NIDA). The U.S. Centers for Disease Control and Prevention reports that more than 47,000 Americans died as a result of opioid overdose in 2017, the year the U.S. Department of Health & Human Services formally declared the epidemic a public health emergency

These overdoses involved prescription opioid medications as well as the illegal drug heroin, and fentanyl, a powerful and deadly synthetic opioid that’s also illegally made and circulating on the streets.

With so many people dying every day, all year long, public health officials, policymakers, and law enforcement officials are racing against time to address the dire situation and its consequences. But amid the fight against addiction and overdose, many want to know what else can be done to end the crisis.

One answer, observers say, is nurse practitioners (NPs). They can fill in where there is a shortage of primary care professionals, who have been a strong line of defense in the opioid addiction battle. However, there is reportedly a severe shortage of these professionals, and it’s one that doesn’t seem to be going anywhere. 

According to a 2018 UnitedHealth Group report, “the supply of primary care physicians is – and will continue to be – insufficient to meet the demand of the population.” 

Also, according to the report, 13 percent of U.S. residents live in a county where there are not enough primary care physicians to treat them. This is concerning, as the challenge of meeting the health needs and demands of a larger, aging, unhealthy population is expected to intensify. This is especially important because people are expected to live longer.

A lack of primary care professionals could affect health care access for people who are struggling with substance abuse and addiction and need treatment. This is where NPs come in.

David Herbert, CEO of the American Association of Nurse Practitioners, and Tommy Thompson, who served as the U.S. Secretary of Health and Human Services from 2001-2005, recently wrote a commentary for Time to share why they think NPs can effectively address the opioid addiction crisis. 

Empowering them, they write, “can go a long way in liberating American patients.” They note that NPs have the required graduate degrees and clinical training to help patients get the care they need. “NPs are qualified to assess patients, order and interpret diagnostic tests, develop treatment plans, and prescribe medications in all 50 states,” Herbert and Thompson said.

One study says that NPs’ presence in the workforce is projected to grow by 6.8 percent between 2016 and 2030. Unless other factors change, it’s unclear how this growth will help opioid-dependent and addicted people.

Hurdles NPS Face

Despite their qualifications and preparedness, NPs face various hurdles that often hinder them from reaching the people who need their help.

Herbert and Thompson highlight several of these hurdles in their commentary, saying strict state restrictions keep NPs from practicing and serving the populations that need them most. A lack of access to NPs likely means many people who have opioid addiction will receive little to no help.

For many NPs, these state-level regulations are keeping them from doing their jobs. States that require NPs to sign a collaborative agreement with doctors can reduce where these professionals get to practice and how they practice.

A University of California San Francisco (UCSF) study highlights how work regulations can block life-saving efforts, even in states where opioid abuse rates are high. 

At least six states with high rates of opioid abuse thwart NPs from prescribing medications that can help treat opioid abuse and addiction, according to this report about the study

“NPs in states requiring that they practice under physician supervision or collaboration are much less likely to get waivers to prescribe these medications, and many of these same states have the highest rates of opioid overdose and addiction,” says the study’s corresponding author Joanne Spetz, Ph.D., an associate director for research at Healthforce Center and UCSF professor. 

The ability for NPs or physician assistants (PAs) to get waivers for buprenorphine, a medication used in Medication-Assisted Treatment, is greatly reduced in states that require physician collaboration or supervision. That because the requirements and/or the supervising physician may not want NPs and PAs to treat opioid-dependent patients.

Easing up on strict regulations can help to reduce the number of overdoses and deaths involving potent opioid pain medications. Having NPs in rural areas, where opioid overdose rates were higher for females than in urban areas in 2017, can benefit communities there. 

UnitedHealth Group’s report notes that NPs are more likely than primary care physicians to practice in underserved communities, including rural areas. It also says that by 2025, the number of NPs practicing primary care will increase 47 percent.

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