Brief Report| Volume 14, ISSUE 10, e213-e216, November 2018

Utilization of the Nurse Practitioner Role to Combat the Opioid Crisis

Published:October 16, 2018DOI:


      • Medication-assisted treatment with buprenorphine is an effective and safe treatment for opioid use disorder.
      • A major barrier to opioid use disorder treatment in the United States is access.
      • Many states currently restrict nurse practitioners from prescribing buprenorphine for opioid use disorder.
      • Access to opioid dependence treatment would be improved by lifting state limitations on buprenorphine prescribing privileges of nurse practitioners.


      The opioid crisis has been deemed an epidemic given its catastrophic effects and dependence outcomes. Unfortunately, access to opioid use disorder (OUD) treatment for opioid dependence remains a significant barrier to effectively addressing this epidemic. The Comprehensive Addiction and Recovery Act granted buprenorphine-prescribing privileges to nurse practitioners with appropriate training. However, many state laws limit this practice, thereby preventing treatment for patients suffering from OUD. These regulations should be revised to allow nurse practitioners to care for patients with opioid dependency, reduce health care costs, and improve patients’ and their families’ quality of life.


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      1. About the U.S. Opioid epidemic. 2018. Accessed April 17, 2018.

        • Rudd R.A.
        • Seth P.
        • David F.
        • Scholl L.
        Increases in drug and opioid-involved overdose deaths—United States, 2010–2015.
        MMWR Morbid Mortal Wkly Rep. 2016; 65: 1445-1452
      2. Schiller EY, Mechanic OJ. Opioid, overdose. StatPearls. Treasure Island, FL: StatPearls Publishing; 2018.

        • Strang J.
        • Babor T.
        • Caulkins J.
        • Fischer B.
        • Foxcroft D.
        • Humphreys K.
        Drug policy and the public good: evidence for effective interventions.
        Lancet. 2012; 379: 71-83
        • Kelly M.A.
        Addressing the opioid epidemic with multimodal pain management.
        Am J Orthoped. 2016; 45: S6-S8
        • Ostling P.S.
        • Davidson K.S.
        • Anyama B.O.
        • Helander E.M.
        • Wyche M.Q.
        • Kaye A.D.
        America’s opioid epidemic: a comprehensive review and look into the rising crisis.
        Curr Pain Headache Rep. 2018; 22: 32
        • Connery H.S.
        Medication-assisted treatment of opioid use disorder: review of the evidence and future directions.
        Harvard Rev Psychiatry. 2015; 23: 63-75
        • Thomas C.P.
        • Fullerton C.A.
        • Kim M.
        • et al.
        Medication-assisted treatment with buprenorphine: assessing the evidence.
        Psychiatr Serv. 2014; 65: 158-170
        • Fullerton C.A.
        • Kim M.
        • Thomas C.P.
        • et al.
        Medication-assisted treatment with methadone: assessing the evidence.
        Psychiatr Serv. 2014; 65: 146-157
        • Gryczynski J.
        • Mitchell S.G.
        • Jaffe J.H.
        • et al.
        Retention in methadone and buprenorphine treatment among African Americans.
        J Subst Abuse Treat. 2013; 45: 287-292
        • Noormohammadi A.
        • Forinash A.
        • Yancey A.
        • Crannage E.
        • Campbell K.
        • Shyken J.
        Buprenorphine versus methadone for opioid dependence in pregnancy.
        Ann Pharmacother. 2016; 50: 666-672
        • Coyle M.G.
        • Salisbury A.L.
        • Lester B.M.
        • et al.
        Neonatal neurobehavior effects following buprenorphine versus methadone exposure.
        Addiction. 2012; 107: 63-73
        • Jones C.M.
        • Baldwin G.T.
        • Manocchio T.
        • White J.O.
        • Mack K.A.
        Trends in methadone distribution for pain treatment, methadone diversion, and overdose deaths—United States, 2002–2014.
        MMWR Morbid Mortal Wkly Rep. 2016; 65: 667-671
        • Cicero T.J.
        • Ellis M.S.
        • Surratt H.L.
        • Kurtz S.P.
        Factors contributing to the rise of buprenorphine misuse: 2008–2013.
        Drug Alcohol Depend. 2014; 142: 98-104
        • Yokell M.A.
        • Zaller N.D.
        • Green T.C.
        • Rich J.D.
        Buprenorphine and buprenorphine/naloxone diversion, misuse, and illicit use: an international review.
        Curr Drug Abuse Rev. 2011; 4: 28-41
        • Jenkinson J.
        • Ravert P.
        Underutilization of primary care providers in treating opiate addiction.
        J Nurse Pract. 2013; 9: 516-522
        • Kourounis G.
        • Richards B.D.
        • Kyprianou E.
        • Symeonidou E.
        • Malliori M.M.
        • Samartzis L.
        Opioid substitution therapy: lowering the treatment thresholds.
        Drug and Alcohol Depend. 2016; 161: 1-8
        • Gryczynski J.
        • Jaffe J.H.
        • Schwartz R.P.
        • et al.
        Patient perspective on choosing buprenorphine over methadone in an urban, equal-access system.
        Am J Addict. 2013; 22: 285-291
        • Kelly S.M.
        • Brown B.S.
        • Katz E.C.
        • et al.
        A comparison of attitudes toward opioid agonist treatment among short-term buprenorphine patients.
        Am J Drug Alcohol Abuse. 2012; 38: 233-238
        • Srivastava A.
        • Kahan M.
        • Nader M.
        Primary care management of opioid use disorders: aqbstinence, methadone, or buprenorphine-naloxone?.
        Can Fam Physician. 2017; 63: 200-205
        • O’Connor A.B.
        Nurse practitioners’ inability to prescribe buprenorphine: limitations of the Drug Addiction Treatment Act of 2000.
        J Am Acad Nurse Pract. 2011; 23: 542-545
        • Bodenheimer T.
        • Bauer L.
        Rethinking the primary care workforce—an expanded role for nurses.
        New Engl J Med. 2016; 375: 1015-1017
        • Jones E.B.
        Medication-assisted opioid treatment prescribers in federally qualified health centers: capacity lags in rural areas.
        J Rural Health. 2018; 34: 14-22
        • St. Marie B.
        • Arnstein P.
        • Zimmer P.A.
        Pain and opioids: call for policy action.
        J Nurse Pract. 2018; 14: 40-44
      3. American Association of Nurse Practitioners. State policy maps 2018. Updated April 26, 2018. Accessed June 6, 2018.

        • Atluri S.
        • Sudarshan G.
        • Manchikanti L.
        Assessment of the trends in medical use and misuse of opioid analgesics from 2004 to 2011.
        Pain Physician. 2014; 17: E119-E128
        • Dasgupta N.
        • Creppage K.
        • Austin A.
        • Ringwalt C.
        • Sanford C.
        • Proescholdbell S.K.
        Observed transition from opioid analgesic deaths toward heroin.
        Drug Alcohol Depend. 2014; 145: 238-241
        • Kolodny A.
        • Courtwright D.T.
        • Hwang C.S.
        • et al.
        The prescription opioid and heroin crisis: a public health approach to an epidemic of addiction.
        Ann Rev Pub Health. 2015; 36: 559-574
        • Palamar J.J.
        • Shearston J.A.
        • Dawson E.W.
        • Mateu-Gelabert P.
        • Ompad D.C.
        Nonmedical opioid use and heroin use in a nationally representative sample of us high school seniors.
        Drug Alcohol Depend. 2016; 158: 132-138
        • Hutchinson E.
        • Catlin M.
        • Andrilla C.H.
        • Baldwin L.M.
        • Rosenblatt R.A.
        Barriers to primary care physicians prescribing buprenorphine.
        Ann Fam Med. 2014; 12: 128-133
        • Salsitz E.
        • Wiegand T.
        Pharmacotherapy of opioid addiction: “putting a real face on a false demon.”.
        J Med Toxicol. 2016; 12: 58-63
        • Woods J.S.
        • Joseph H.
        Reducing stigma through education to enhance medication-assisted recovery.
        J Addict Dis. 2012; 31: 226-235
        • Huhn A.S.
        • Dunn K.E.
        Why aren’t physicians prescribing more buprenorphine?.
        J Subst Abuse Treat. 2017; 78: 1-7
        • Andrilla C.H.
        • Coulthard C.
        • Larson E.
        Barriers rural physicians face prescribing buprenorphine for opioid use disorder.
        Ann Fam Med. 2017; 15: 359-362
        • Wielen L.M.
        • Gilchrist E.C.
        • Nowels M.A.
        • Petterson S.M.
        • Rust G.
        • Miller B.F.
        Not near enough: Racial and ethnic disparities in access to nearby behavioral health care and primary care.
        J Health Care Poor Underserved. 2015; 26: 1032-1047
        • Fagan E.B.
        • Gibbons C.
        • Finnegan S.C.
        • et al.
        Family medicine graduate proximity to their site of training: policy options for improving the distribution of primary care access.
        Fam Med. 2015; 47: 124-130
        • Scott A.
        • Witt J.
        • Humphreys J.
        • et al.
        Getting doctors into the bush: general practitioners’ preferences for rural location.
        Soc Sci Med. 2013; 96: 33-44
        • Rosenblatt R.A.
        • Andrilla C.H.
        • Catlin M.
        • Larson E.H.
        Geographic and specialty distribution of US physicians trained to treat opioid use disorder.
        Ann Fam Med. 2015; 13: 23-26
        • Stein B.D.
        • Dick A.W.
        • Sorbero M.
        • et al.
        A population-based examination of trends and disparities in medication treatment for opioid use disorders among medicaid enrollees.
        Subst Abuse. 2018; ([epub ahead of print])
        • Broyles L.M.
        • Conley J.W.
        • Harding Jr., J.D.
        • Gordon A.J.
        A scoping review of interdisciplinary collaboration in addictions education and training.
        J Addict Nurs. 2013; 24 (quiz 7-8): 29-36
        • Myers C.R.
        • Alliman J.
        Updates on the quest for full practice authority.
        J Nurse Pract. 2018; 14: 559-565


      Heather J. Jackson, MSN, FNP-BC, is the Assistant Director of Outpatient Surgery, Advance Practice Team Lead Interventional Pain Center, Vanderbilt University Medical Center, Nashville, TN.


      Cristina Lopez, PhD is an assistant professor, Diversity & Inclusion Officer, Co-Director, Office of Gender Equity, College of Nursing, Medical University of South Carolina, Charleston, SC.