State Legislation Encouraging Access to Treatment for Opioid Use Disorder

October 05, 2017|3:59 p.m.| ASTHO Staff

In 2016, both Congress and HHS took steps to expand access to treatment for opioid use disorder. HHS increased the maximum number of patients a physician can treat under the buprenorphine waiver program from 100 to 275. Of the more than 40,000 physicians currently certified under the buprenorphine waiver program, over 3,000 are certified to treat up to 275 patients. Congress enacted the Comprehensive Addiction and Recovery Act of 2016 (CARA), which includes a five-year pilot program for nurse practitioners (NPs) and physician assistants (PAs) to obtain waivers to prescribe and dispense buprenorphine. To qualify, NPs and PAs must complete 24 hours of training (available at no cost) and are limited to treating 30 patients for their first year. Additionally, NPs and PAs must be licensed under state law to prescribe schedule III, IV, or V pain medications. If a jurisdiction requires NPs and PAs to prescribe or dispense medication in collaboration with or under the supervision of a physician, the collaborating or supervising physician must also obtain a waiver to prescribe buprenorphine.

During the 2017 state legislative sessions, state policymakers also explored ways to encourage NPs and PAs to prescribe and dispense buprenorphine. On Sept. 11, California codified key components of CARA into state law and clarified that the state’s nursing and physician assistant practice acts are not to be construed to prohibit NPs and PAs from providing buprenorphine in compliance with CARA (SB 554 [2017]). In Colorado, legislators enacted SB 74 (2017), establishing a two-year medication-assisted treatment (MAT) expansion pilot program. The state appropriated $500,000 from its retail marijuana tax revenues for a grant program to serve two counties that are disproportionately impacted by the opioid epidemic and provide limited access to MAT. Grant recipients, which may be community agencies, office-based practices, behavioral health organizations, and substance abuse treatment organizations, can apply for grants to help their NPs and PAs obtain training to prescribe buprenorphine and provide behavioral therapies to patients receiving MAT. The University of Colorado College of Nursing will administer the grants, which must be awarded no later than Jan. 1, 2018.

Recognizing the important need for state and territorial public health to be a leading voice during the current opioid epidemic, ASTHO will continue to highlight public health policy approaches for the prevention and treatment of opioid use disorder. More information about how state and territorial health agencies are responding to the opioid crisis can be found in ASTHO’s Preventing Opioid Misuse in the States and Territories strategic framework.