Projected Contributions of Nurse Practitioners and Physicians Assistant to Buprenorphine Treatment Services for Opioid Use Disorder in Rural Areas

2018 ◽  
Vol 77 (2) ◽  
pp. 208-216 ◽  
Author(s):  
C. Holly A. Andrilla ◽  
Davis G. Patterson ◽  
Tessa E. Moore ◽  
Cynthia Coulthard ◽  
Eric H. Larson
Keyword(s):  
New England ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Physician Assistants ◽  
The United States ◽  
Opioid Use Disorder ◽  
Prescribe Medication ◽  
Opioid Use ◽  
South Central ◽  
Rural Patients

The United States is experiencing an opioid use disorder epidemic. The Comprehensive Addiction and Recovery Act allows nurse practitioners (NPs) and physician assistants (PAs) to obtain a Drug Enforcement Administration waiver to prescribe medication-assisted treatment (MAT) for opioid use disorder. This study projected the potential increase in MAT availability provided by NPs and PAs for rural patients. Using workforce and survey data, and state scope of practice regulations, the number of treatment slots that could be provided by NPs and PAs was estimated for rural areas. NPs and PAs are projected to increase the number of rural patients treated with buprenorphine by 10,777 (15.2%). Census Divisions varied substantially in the number of projected new treatment slots per 10,000 population (0.8-10.6). The New England and East South Central Census Divisions are projected to have the largest population-adjusted increase. NPs and PAs have considerable potential to reduce substantial MAT access disparities.

Knowledge gaps and practice patterns of clinicians treating patients with opioid use disorder

2019 ◽  
Vol 15 (6) ◽  
pp. 455-468 ◽  
Author(s):  
Maziar Rasulnia, PhD ◽  
Billy Stephen Burton, MS ◽  
Dhiren Patel, PharmD
Keyword(s):  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
Practice Patterns ◽  
Physician Assistants ◽  
Opioid Use Disorder ◽  
Audit And Feedback ◽  
Primary Study ◽  
Opioid Use ◽  
Knowledge Gaps ◽  
Survey Tool

Objective: The goal of the study was to assess knowledge gaps and practice patterns of US-based addiction specialists, primary care physicians (PCPs), nurse practitioners (NPs), and physician assistants (PAs) who treat patients with opioid use disorder (OUD).Design: As part of a prospective study, the authors developed a survey tool consisting of case-vignettes and questions designed to reveal practice patterns and highlight gaps in clinician knowledge.Setting: The primary study setting included clinicians practicing in outpatient care.Participants: The surveys were distributed via email between August and September 2017 to a national sample of addiction specialists, PCPs, and NPs/Pas that see at least one patient per week and at least 1 percent of their patient population had to be diagnosed with OUD.Results: The knowledge assessment results varied among the clinicians surveyed. Addiction specialists saw more patients with OUD than PCPs, NPs, or PAs. They also demonstrated a higher level of understanding and knowledge of the various domains assessed.Conclusions: There are multiple educational intervention strategies that can support the clinicians; including reducing restrictions to access treatment for OUD, care coordination programs for patients to improve early access to treatment and education, and frequent chart audit and feedback programs to support clinician decision making and education.

Primary Care and Physician Extenders in Affluent Countries

1977 ◽  
Vol 7 (4) ◽  
pp. 545-555 ◽  
Author(s):  
Milton I. Roemer
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Physician Assistants ◽  
The United States ◽  
Industrialized Countries ◽  
Major Response ◽  
Urban And Rural Areas ◽  
Physician Extenders

The worldwide growth of specialization in medicine has led to a perceived shortage of primary care. A major response in the United States has been the training of physician extenders (both physician assistants and nurse practitioners). Other industrialized countries have rejected this approach, in favor of strengthening general medical practice through continuing education, provision of ancillary personnel, use of health centers, and by other methods. Developing countries use doctor-substitutes as a reasonable adjustment to their lack of economic resources. All countries use ancillary personnel for selected procedures, such as midwifery, which involve only limited judgment and decision making. The American strategy on use of doctor-substitutes for primary care, however, follows from unwillingness to train greater numbers of primary care physicians and to require them to serve in places of need. This results in an inequitable concentration of doctor-substitutes on service to the poor in both urban and rural areas.

Stigma Associated with Opioid Use Disorder and Medication Assisted Treatment

2019 ◽  
Author(s):  
Dr. Harry Holt
Keyword(s):  
Primary Care ◽  
Maintenance Therapy ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Negative Stereotypes ◽  
Medication Assisted Treatment

<b>Purpose</b>: This paper reviews and integrates the literature on the stigma associated with opioid use disorder (OUD) and how this acts as a barrier for patients seeking Medication Assisted Treatment (MAT). Implications for patients in rural areas who face stigma for opioid use disorder are reviewed. <b>Methods: </b>We examine the extant literature since 2007, reviewing studies focused on the stigma against patients suffering from OUD and MAT. <b>Findings</b>: The review identifies five categories of sources of stigma that research has addressed: Stigma against the patient; stigma by nurses; stigma by primary care physicians; stigma from counselors; stigma by pharmacy and dispensary staff; stigma against MAT by drug courts, stigma by family members, coworkers, and employers. <b>Conclusions</b>: Stigma exists as prejudice, negative stereotypes and associations, and labels. Despite widespread evidence supporting Methadone Maintenance Therapy (MMT) and Buprenorphine Maintenance Therapy (BMT) effectiveness, stigma abounds within the medical community and society at large. Discriminatory practices, poor relationships with dispensing staff, pharmacists, counselors, and doctors, and a feeling of being separate or “alien” from others are cited as barriers to involvement and participation in MAT. This has created disparities in health care outcomes as well as the access and availability of MAT services. Rural patients experience these sources of stigma and face a heightened barrier to access for MAT services. However, the primary care setting along with delivery of care through primary care physicians, physician assistants, and nurse practitioners offers a means to increase care in rural areas.

Stigma Associated with Opioid Use Disorder and Medication Assisted Treatment

2019 ◽  
Author(s):  
Dr. Harry Holt
Keyword(s):  
Primary Care ◽  
Maintenance Therapy ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Primary Care Physicians ◽  
Methadone Maintenance ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Negative Stereotypes ◽  
Medication Assisted Treatment

<b>Purpose</b>: This paper reviews and integrates the literature on the stigma associated with opioid use disorder (OUD) and how this acts as a barrier for patients seeking Medication Assisted Treatment (MAT). Implications for patients in rural areas who face stigma for opioid use disorder are reviewed. <b>Methods: </b>We examine the extant literature since 2007, reviewing studies focused on the stigma against patients suffering from OUD and MAT. <b>Findings</b>: The review identifies five categories of sources of stigma that research has addressed: Stigma against the patient; stigma by nurses; stigma by primary care physicians; stigma from counselors; stigma by pharmacy and dispensary staff; stigma against MAT by drug courts, stigma by family members, coworkers, and employers. <b>Conclusions</b>: Stigma exists as prejudice, negative stereotypes and associations, and labels. Despite widespread evidence supporting Methadone Maintenance Therapy (MMT) and Buprenorphine Maintenance Therapy (BMT) effectiveness, stigma abounds within the medical community and society at large. Discriminatory practices, poor relationships with dispensing staff, pharmacists, counselors, and doctors, and a feeling of being separate or “alien” from others are cited as barriers to involvement and participation in MAT. This has created disparities in health care outcomes as well as the access and availability of MAT services. Rural patients experience these sources of stigma and face a heightened barrier to access for MAT services. However, the primary care setting along with delivery of care through primary care physicians, physician assistants, and nurse practitioners offers a means to increase care in rural areas.

States Should Remove Barriers to Advanced Practice Registered Nurse Prescriptive Authority to Increase Access to Treatment for Opioid Use Disorder

2020 ◽  
pp. 152715442097872
Author(s):  
Hayley D. Germack
Keyword(s):  
Substance Use ◽  
Nurse Practitioners ◽  
Rural Areas ◽  
Registered Nurse ◽  
Opioid Use Disorder ◽  
Advanced Practice ◽  
Opioid Use ◽  
Access To Treatment ◽  
State Planning ◽  
Prescriptive Authority

In October 2018, President Trump signed into law H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act. This piece of legislation addresses treatment, prevention, recovery, and enforcement with particular attention to access in rural areas. It contains numerous provisions to improve needed access to treat substance use disorders and especially opioid use disorder (OUD), including mandatory coverage of medications for OUD, partial elimination of Medicaid payment for inpatient mental health treatment, and state planning grants to increase provider capacity. Many of these provisions would be significantly enhanced by removing barriers to prescriptive authority for Advanced Practice Registered Nurses (APRNs), including Nurse Practitioners, Clinical Nurse Specialists, Certified Nurse Midwives, Certified Registered Nurse Anesthetists, and other state-specific titles for nurses whose scope allows the prescription of controlled substances. This policy brief includes a history of the role of APRNs in the delivery of medications for OUD, scope of practice restrictions related to prescriptive authority as a barrier in their ability to deliver care for this vulnerable population, and actionable strategies that APRNs can take to advocate for an increased role in providing care.

scholarly journals The Impact of CARA Mandates on Nurse Practitioner Controlled Substance Prescribing in Oregon: A Cohort Study

2021 ◽  
Author(s):  
Tracy A Klein ◽  
Daniel Hartung ◽  
Sheila Markwardt
Keyword(s):  
Nurse Practitioners ◽  
Monitoring Program ◽  
The United States ◽  
Opioid Use Disorder ◽  
Disciplinary Action ◽  
Opioid Use ◽  
Chi Square ◽  
Risk Patients ◽  
Controlled Substance ◽  
The Impact

Abstract Background: In 2017, the United States Comprehensive Addiction and Recovery Act (CARA) expanded authorization to prescribe buprenorphine for opioid use disorder to nurse practitioners (NPs). In contrast to physicians, NPs were required to complete 16 additional hours of training on controlled substance prescribing before a buprenorphine waiver application. As this differential additional education mandate was seen as a potential barrier, we sought to evaluate the impact of this requirement on both waiver acquisition and prescribing of controlled substances, comparing NPs who obtained waivers to those who had not.Methods: Through 2016-2018 Oregon Prescription Drug Monitoring Program and linked NP licensure data, we identify factors associated with waiver acquisition at baseline (2016), and evaluated changes in controlled substance prescribing before (2016) and after waiver acquisition (2018). Using chi-square and Mann-Whitny U testing, we calculated and described controlled substance prescribing types, rates, and patient level quantities including co-prescribing of benzodiazepines and opioids by NPs. Multivariable linear regression compared prescribing by waivered and non-waivered NPs for significant changes in non-buprenorphine controlled substance prescribing.Results: Waivered NPs were more likely to have a psychiatric certification, have prior disciplinary action, and have generally higher levels of non-buprenorphine controlled substance prescribing than their non-waivered counterparts.. While there was a significant increase in opioid prescriptions per patient among waivered NPs, following CARA implementation, co-prescribing of benzodiazepines and opioids significantly declined among waivered NPs relative to non-waivered NPsConclusions: Although educational requirements were rescinded in 2021 for most applicants, enhanced opioid prescribing training should be incorporated into professional educational offerings regardless of regulatory mandate. We recommended continued focus on education regarding avoidance of high risk prescribing such as co-prescribing of opioids and benzodiazepines. NPs who acquire waivers may take on higher risk patients who are already using opioids and these findings may represent transitions in practice and patient setting.

scholarly journals Patient Satisfaction With Medications for Opioid Use Disorder Treatment via Telemedicine: Brief Literature Review and Development of a New Assessment

2021 ◽  
Vol 8 ◽  
Author(s):  
Thomas O. Cole ◽  
Darlene Robinson ◽  
Andrea Kelley-Freeman ◽  
Devang Gandhi ◽  
Aaron D. Greenblatt ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Rural Areas ◽  
The United States ◽  
Opioid Use Disorder ◽  
Future Research ◽  
Opioid Use ◽  
Addiction Medicine ◽  
Feasible Method ◽  
Clinical Interest ◽  
Disorder Treatment

Telemedicine is increasingly being used to treat patients with opioid use disorder (OUD). It has particular value in rural areas of the United States impacted by the opioid crisis as these areas have a shortage of trained addiction medicine providers. Patient satisfaction significantly impacts positive clinical outcomes in OUD treatment and thus is of great clinical interest. Yet little is known regarding patient satisfaction with the increasingly important platform of telemedicine-delivered medications for opioid use disorder (tMOUD). The goal of this review is to provide a summary of the existing literature regarding patient satisfaction with tMOUD. We also submit a novel survey based on an existing framework designed to assess tMOUD satisfaction, and present pilot data (N = 14) acquired from patients engaged in rural tMOUD care. Telemedicine provides a feasible method for delivering MOUD in rural areas, and our survey provides a useful assessment to measure patient satisfaction with tMOUD. In light of the pressing need for innovative and technology-driven solutions to the opioid epidemic (especially in light of the COVID-19 pandemic), future research should focus on the development and refinement of tools to assess the important implementation goal of patient satisfaction.

scholarly journals Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

2021 ◽  
pp. 002204262110063
Author(s):  
Brian King ◽  
Ruchi Patel ◽  
Andrea Rishworth
Keyword(s):  
Age Groups ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Policy Recommendations ◽  
Opioid Use ◽  
Fentanyl Analogs ◽  
Measure Change ◽  
Using Data ◽  
At Home

COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection.

scholarly journals “It’s way more than just writing a prescription”: A qualitative study of preferences for integrated versus non-integrated treatment models among individuals with opioid use disorder

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Elizabeth C. Saunders ◽  
Sarah K. Moore ◽  
Olivia Walsh ◽  
Stephen A. Metcalf ◽  
Alan J. Budney ◽  
...  
Keyword(s):  
Qualitative Study ◽  
The United States ◽  
Opioid Use Disorder ◽  
Integrated Treatment ◽  
Medical Setting ◽  
Integrated Models ◽  
Opioid Use ◽  
Medical Settings ◽  
Psychosocial Services ◽  
Treatment Models

Abstract Background Increasingly, treatment for opioid use disorder (OUD) is offered in integrated treatment models addressing both substance use and other health conditions within the same system. This often includes offering medications for OUD in general medical settings. It remains uncertain whether integrated OUD treatment models are preferred to non-integrated models, where treatment is provided within a distinct treatment system. This study aimed to explore preferences for integrated versus non-integrated treatment models among people with OUD and examine what factors may influence preferences. Methods This qualitative study recruited participants (n = 40) through Craigslist advertisements and flyers posted in treatment programs across the United States. Participants were 18 years of age or older and scored a two or higher on the heroin or opioid pain reliever sections of the Tobacco, Alcohol, Prescription Medications, and Other Substances (TAPS) Tool. Each participant completed a demographic survey and a telephone interview. The interviews were coded and content analyzed. Results While some participants preferred receiving OUD treatment from an integrated model in a general medical setting, the majority preferred non-integrated models. Some participants preferred integrated models in theory but expressed concerns about stigma and a lack of psychosocial services. Tradeoffs between integrated and non-integrated models were centered around patient values (desire for anonymity and personalization, fear of consequences), the characteristics of the provider and setting (convenience, perceived treatment effectiveness, access to services), and the patient-provider relationship (disclosure, trust, comfort, stigma). Conclusions Among this sample of primarily White adults, preferences for non-integrated versus integrated OUD treatment were mixed. Perceived benefits of integrated models included convenience, potential for treatment personalization, and opportunity to extend established relationships with medical providers. Recommendations to make integrated treatment more patient-centered include facilitating access to psychosocial services, educating patients on privacy, individualizing treatment, and prioritizing the patient-provider relationship. This sample included very few minorities and thus findings may not be fully generalizable to the larger population of persons with OUD. Nonetheless, results suggest a need for expansion of both OUD treatment in specialty and general medical settings to ensure access to preferred treatment for all.

scholarly journals Discovering Non-Invasive Biomarkers Predictive of Opioid Use Disorder Treatment Response

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 173-173
Author(s):  
Amir Levine ◽  
Kelly Clemenza ◽  
Shira Weiss ◽  
Adam Bisaga ◽  
Erez Eitan ◽  
...  
Keyword(s):  
Treatment Response ◽  
Mononuclear Cells ◽  
Specific Treatment ◽  
The United States ◽  
Opioid Use Disorder ◽  
Response To Treatment ◽  
Post Translational Modification ◽  
Opioid Use ◽  
Peripheral Blood Mononuclear ◽  
Long Term Treatment

AbstractBackgroundOpioid use disorder (OUD) continues to be the driving force behind drug overdoses in the United States, killing nearly 47,000 people in 2018 alone. The increasing presence of deadlier fentanyl analogues in the heroin drug supply are putting users at a greater risk for overdose than ever before. Admissions to treatment programs for OUD have also nearly doubled since 2006, yet relapse rates remain high. In response to these alarming statistics, developing approaches to reduce overdose deaths has become an area of high priority. As it is not yet known which patients are most likely to benefit from a specific treatment, there is a dire need to utilize new molecular tools to guide precision medicine approaches and improve treatment outcomes. Here we describe a proof-of-concept study evaluating plasma-derived extracellular vesicle (EV) signatures and how they differ in patients who responded to two pharmacologically contrasting treatments for OUD: the μOR agonist methadone, and the μOR antagonist naltrexone.MethodsWe obtained blood samples from patients with OUD who remained abstinent from illicit opioids for at least 3 months during treatment with methadone (n=5) and naltrexone (n=5), as well as matched healthy controls (n=5). EVs were isolated from plasma and histones were isolated from peripheral blood mononuclear cells (PBMCs). EVs were then analyzed for lipid and histone post-translational modification (PTM) content using liquid chromatography-mass spectrometry. EV miRNA cargo was determined by RNA sequencing.ResultsWe found one lipid class and six miRNAs that differed significantly between the naltrexone group and the methadone and control groups. We also found that histone H3acK9acK14 was increasingly acetylated in PMBCs from both the methadone and naltrexone groups compared to controls.DiscussionNaltrexone, which is used in treatment of OUD and other substance use disorders as well as disorders of impulse control, was found to have multiple potential corresponding molecular signatures that can be identified after long-term treatment. It remains to be seen if these markers can also be a good predictor for treatment response. In addition, significant gender differences in EV content are found between men and women with OUD, which supports the importance of examining changes in response to treatment in a gender informed way.

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