CNS Communiqué

CNSs INCLUDED IN EXPANDED TREATMENT OPTIONS FOR PATIENTS WITH OPIOID USE DISORDERS

In October 2018, NACNS commended President Trump for signing into law P.L. 115-271, also known as H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act.  Section 3201 of SUPPORT provides lasting authority for NPs and PAs to prescribe buprenorphine through medication-assisted treatment (MAT).  This action permanently extends these providers’ authority, granted originally in 2016, for only five years via Public Law 114-198, the Comprehensive Addiction and Recovery Act (CARA).  NACNS advocated for CARA and yet, while supporting that law as a “good start,” noted that it fell far short of what was really needed as it failed to include CNSs, who can prescribe MAT.  NACNS argued, “[c]linical nurse specialists have the same education and training as other advance practice registered nurses.  Allowing CNSs to practice to the full scope of their education and training will not only increase the pool of qualified health professionals but also improve access to care.”

Through the years, NACNS has pressed its position to expand patients’ access to treatment by allowing authority to CNSs who are lawful prescribers of MAT (e.g., NACNS comments on the implementation of Section 704 of CARA, December 1, 2016 and NACNS’s three Opioid Position Statements).  NACNS’s advocacy paid off as Section 3201 of the SUPPORT Act also gives CNSs, CRNAs and CNMs prescribing authority for five years, until October 1, 2023.

Training is required in order to apply to become Drug Addiction Treatment Act (DATA) waiver practitioners who prescribe or dispense buprenorphine for opioid dependency treatment.  The Substance Abuse and Mental Health Services Administration (SAMHSA) already has a regulatory framework to qualify for NP and PA DATA waivers.

This NP/PA framework, which may become the model for a CNS waiver, mandates no fewer than 24 hours of initial training provided by certain organizations, such as the American Society of Addiction Medicine (ASAM).  While SAMHSA is promulgating regulations for CNS waivers, NACNS and ASAM have begun exploring possible collaboration to offer training to CNSs interested in seeking a waiver to prescribe buprenorphine.

In addition to Section 3201, other SUPPORT provisions may have implications for CNS practice in addressing the opioid crisis, such as:

♦  Providing R&D funding for new nonaddictive and nonopioid drugs and treatments.

♦  Authorizing Centers for Disease Control and Prevention grants for states and localities to improve their prescription drug-monitoring programs.

♦  Expanding the use of telehealth services for Medicaid and Medicare substance use disorder (SUD) treatment.

♦  Providing loan repayment for SUD-treatment providers who agree to work in mental health professional shortage areas or counties that have been hardest hit by drug overdoses.

♦  Developing educational materials for clinicians to use with pregnant women for shared decision-making regarding pain management during pregnancy.