University of California San Francisco School of Nursing, Department of Social and Behavioral Sciences, 490 Illinois Street, 12th Floor, San Francisco, CA 94143, United States of America.
UCSF School of Medicine, 533 Parnassus Ave, San Francisco, CA 94143, United States of America.
J Subst Use Addict Treat. 2024 Feb;157:209215. doi: 10.1016/j.josat.2023.209215. Epub 2023 Nov 18.
Deaths from drug overdoses are rising dramatically in the United States. Treatment for opioid use disorders may include behavioral treatments as well as medications for opioid use disorders (MOUD). Buprenorphine can be prescribed by physicians, nurse practitioners (NPs), other advanced practice registered nurses (APRNs), and physician assistants (PAs) and required a training and a federal waiver until recently. The number of NP MOUD prescribers grew steadily over the past decade, but research has identified state-level scope of practice regulations as a barrier to NP MOUD prescribing. This article explores the contributions of, and remaining barriers faced by NP and other APRN MOUD prescribers. We describe qualitative findings from a study of NPs and other key stakeholders involved in MOUD treatment in four states with two differing levels of regulatory structure.
In this qualitative study, we conducted site visits and semi-structured interviews with NPs and other APRNs, physicians, clinic managers, and regulators in four states including New Mexico and West Virginia (full practice authority for NPs), and Ohio and Michigan (which require physician supervision). Interview notes were entered into a qualitative software package and coded and reviewed by two members of the research team. Data were grouped into key themes.
A total of 76 participants participated in individual or small group interviews in the four states. We found key themes and several subthemes that describe NP practice in MOUD. Participants described key contributions of NP engagement in MOUD, including increasing access, serving rural areas, the unique role of psychiatric NPs, and the value of the nursing model of care in working with people with substance use disorders (SUD). Participants also identified barriers including scope of practice regulations, other regulatory barriers, stigma, and lack of supportive services to address psychosocial needs.
The waiver requirements were eliminated at the end of 2022 in federal budget legislation. Other barriers for NP and other APRN prescribers remain and should be addressed in practice, and in state and federal regulations. Research needs to explore the impact of the waiver elimination on MOUD prescribing and access to services.
美国的药物过量死亡人数正在急剧上升。阿片类药物使用障碍的治疗可能包括行为治疗以及阿片类药物使用障碍（MOUD）的药物治疗。布比卡因可由医生、护士从业者（NP）、其他高级实践注册护士（APRN）和医师助理（PA）开具处方，并在最近之前需要培训和联邦豁免。过去十年中，NP 的 MOUD 处方数量稳步增长，但研究发现，州级实践范围法规是 NP MOUD 处方的障碍。本文探讨了 NP 和其他 MOUD 处方者的贡献以及仍然面临的障碍。我们描述了在四个州对 NP 和其他参与 MOUD 治疗的主要利益相关者进行的一项研究的定性发现，这些州的监管结构存在差异。
在这项定性研究中，我们对四个州（包括新墨西哥州和西弗吉尼亚州（NP 完全执业权）和俄亥俄州和密歇根州（需要医生监督））的 NP 和其他 APRN、医生、诊所经理和监管机构进行了现场访问和半结构化访谈。采访笔记被输入到定性软件包中，并由研究团队的两名成员进行编码和审查。数据被分组为关键主题。
共有 76 名参与者在四个州参加了个人或小组访谈。我们发现了描述 NP 在 MOUD 中实践的关键主题和几个子主题。参与者描述了 NP 参与 MOUD 的主要贡献，包括增加获得途径、服务农村地区、精神病学 NP 的独特角色以及护理模式在治疗药物使用障碍（SUD）患者方面的价值。参与者还确定了包括实践范围法规、其他监管障碍、污名和缺乏解决心理社会需求的支持性服务在内的障碍。
联邦预算立法已于 2022 年底取消了豁免要求。NP 和其他 APRN 处方者仍然存在其他障碍，这些障碍应在实践中以及州和联邦法规中得到解决。需要研究豁免取消对 MOUD 处方和获得服务的影响。
