Advanced Practice Providers Critical in Reversing America’s Opioid Crisis

For Richard Bottner, a physician assistant practicing hospital medicine and palliative care at a community hospital in Texas, it’s common for him to encounter patients suffering from opioid use disorder. So, he decided to learn more about OUD, but he had no idea that what he would learn would end up saving a patient’s life.

After hearing about a waiver that allows PAs and nurse practitioners to prescribe buprenorphine — a type of medication-assisted treatment — to treat OUD, Bottner signed up for the course required to attain the waiver. He continued to learn more about treating OUD and formed a multidisciplinary and interprofessional team specializing in buprenorphine inductions in the hospital setting. Previously, the best they could offer patients suffering from OUD — other than treating acute withdrawal — was a one-page list of outside agencies that could provide support after a patient was discharged.

A short time later, a distressed and agitated patient presenting all the signs of OUD and other comorbidities arrived at his hospital. Bottner’s team sprang into action and started the buprenorphine therapy. The patient made an incredibly positive turnaround in just a few short days. Based on his condition, Bottner firmly believes that without buprenorphine, the patient would not have lived.

In 2016, PAs and NPs were granted the ability to obtain waivers to treat substance use disorder patients with buprenorphine through October 2021 as part of the Comprehensive Addiction and Recovery Act. Since the enactment of CARA, more than 5,000 PAs and NPs have gone through the required training and applied for the waiver — allowing them to provide this life-saving treatment.

The Senate is currently considering bipartisan legislation that would make this waiver authorization permanent for PAs and NPs. Earlier this year, the House passed legislation with the same provision. The House bill also provided a five-year authorization for certified nurse-midwives, certified nurse anesthetists, and clinical nurse specialists to prescribe MAT.

MAT — one approach to stemming the opioid crisis — is the gold standard when it comes to life-saving OUD treatment. The combination of behavioral therapy and Food and Drug Administration-approved medication to treat OUD has proven to be effective.

According to research by the Pew Charitable Trusts, MAT “significantly reduces illicit opioid use” in comparison to nondrug approaches, and with more access to MAT, overdose fatalities are reduced. However, the study also notes that MAT is often unavailable to patients who need it because of “a lack of qualified providers who can deliver these therapies.”

Access to MAT would be improved if there were more providers able to prescribe buprenorphine. Unlike methadone treatment, which is performed in a structured clinic, buprenorphine can be prescribed in outpatient medical offices. This means that patients who feel more comfortable in a traditional health care setting can seek treatment from a provider they may have an established relationship with — someone they know and trust. That provider may, of course, be a PA, NP or physician.

PAs and NPs are both highly educated, well-trained health care providers who place the patient at the center of their care. There are more than 123,000 PAs and more than 248,000 NPs in the United States, many of whom practice in primary care or addiction medicine. Their daily interactions with patients in all care settings make PAs and NPs an essential part of the solution to the opioid crisis — especially with increased access to the buprenorphine waiver.

It’s estimated that only 10 percent of those needing treatment for OUD are currently receiving it. For that reason alone, it’s crucial that we give qualified health care providers, like PAs and NPs, the tools they need to treat patients. Without permanent buprenorphine waivers for PAs and NPs, critical access to care can slip away.

Additionally, it’s a significant commitment for clinicians taking the training to obtain a waiver and one that is increasingly difficult to make, as such waivers face an uncertain future. This is why it’s vital for the Senate to pass legislation that would make this waiver authorization permanent for PAs and NPs.

Making these waivers permanent is not only good for patients, but it’s also good for the country. The Drug Enforcement Administration estimates that over five years, the net economic benefit of the existing waiver program will be $808 million. We are in the midst of an opioid crisis that continues to affect far too many. Expanding access to MAT is an important step forward in addressing this crisis.

Health care providers such as Bottner are our first line of defense in stemming this growing crisis. PAs and NPs are qualified health care providers who see patients every day in need of this critical treatment. They are well-positioned to help end this crisis — so let’s make sure they have what they need.


Dr. Jonathan E. Sobel, PA-C, DMSc, MBA, DFAAPA, FAPACVS, is president of the American Academy of PAs and chair of the board of directors.

Morning Consult welcomes op-ed submissions on policy, politics and business strategy in our coverage areas. Updated submission guidelines can be found here.

Jonathan E. Sobel is a doctor of medical science. A previous version of the op-ed had an incorrect credential.

Morning Consult