LONG BEACH, Calif. — Healthcare providers with advanced practice credentials should consider getting federal waivers to prescribe buprenorphine in the ongoing fight against the opioid epidemic, experts said.

“There are a whole slew of benefits for patients who end up on medications for their opioid use disorder [OUD]. These medications do save lives,” said Amanda Simonton, PhD, APRN, in a presentation at the American Psychiatric Nurses Association (APNA) annual meeting.

“Individuals who do not receive medications for OUD are at a 2.5 times higher risk of all-cause mortality, and they’re at an eight times higher risk for an overdose death,” she noted, citing data from a 2021 meta-analysis.

The 2016 CARA Act allowed advanced practice providers to become “qualifying providers” and obtain the waiver after 24 hours of training, Simonton said. This change became permanent per the 2018 SUPPORT Act. In 2021, the Department of Health and Human Services allowed qualified providers to bypass the training and prescribe the drug for up to 30 patients by filing a “Notice of Intent.”

“There are a few feelings about the waiver and whether we need it or not,” Simonton said. “This is at least a step in a direction for reducing barriers.”

But providers may not be exercising their option to prescribe OUD meds. Lauren Meadows, RN, of Integral Care in Austin, Texas, said in her APNA presentation that research indicated that only about 8% of advanced practice registered nurses (APRN) had gotten their “X-waivers.” The waivers seem to be less common in states with tighter restrictions regarding physician oversight of advanced practice practitioners, she noted. Meadows said one avenue to boost the number of waivered providers would be to include X-waiver (also known as a DATA waiver) training in APRN programs.

Donna Rolin, PhD, APRN, of the University of Texas at Austin, stressed that “we all know that opioid use disorder is a public health crisis. And we’re well positioned to address this issue. Yet we need to have the training and confidence to be able to provide treatment with FDA-approved medications.” She urged colleagues to undergo training — via Providers’ Clinical Support System through the Substance Abuse and Mental Health Services Administration, for example — and obtain waivers.

Simonton pointed out that there are currently three FDA-approved first-line medications to treat OUD, but only about 10% of patients with OUD benefit from the treatment, despite “evidence that all three of these medications improve recovery, lengthen recovery episodes, and have a number of other benefits.” The agents are:

• Naltrexone: Recommended after 7-14 days of opioid abstinence. If this guidance is not followed, “you’re going to throw your patient into precipitated withdrawal, and they’re not going to be very happy with you,” she cautioned. Naltrexone is a different medication than naloxone (Narcan) that reverses opioid overdoses.
• Methadone: Only prescribed for this indication in federally certified opioid treatment programs. Simonton said this is a Drug Enforcement Agent (DEA) schedule II medication, and advanced practice providers in some states may not be legally able to prescribe it. “Methadone is usually given daily through an opioid treatment program, and patients will receive it by going to those facilities. There’s a lot of structure and accountability,” she noted.
• Buprenorphine: A DEA schedule III drug that Simonton said “can be obtained through an office-based setting. It does not have to be limited to an opioid treatment program. It’s very useful if patients can sustain being in an outpatient setting.”

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