Providers’ Clinical Support System for Medication Assisted Treatment (PCSS-MAT) has launched a 24-hour course on treating opioid use disorder that will allow nurse practitioners (NPs) and physician assistants (PAs) to apply for a waiver from the Substance Abuse and Mental Health Services Administration (SAMHSA) to begin prescribing buprenorphine.
PCSS-MAT, a coalition of healthcare organizations led by the American Academy of Addiction Psychiatry (AAAP), is providing the course jointly with continuing education by the American Psychiatric Nurses Association and the American Academy of PAs. The project is funded by SAMHSA. Per authorization in the Comprehensive Addiction and Recovery Act (CARA), NPs and PAs will be will be eligible to apply to SAMHSA for a waiver for prescribing buprenorphine after completing an eight-hour MAT waiver course and 16 hours of training in treating opioid use disorders.
“With CARA and even before that, we felt very strongly that it’s about interdisciplinary teams, not just physicians only,” says Kathryn Cates-Wessel, executive director of the AAAP. “We’ve been a strong advocate for getting nurse practitioners and PAs prescribing abilities. When CARA came through, we were very interested and supportive. We’ve been a big proponent of multidisciplinary approaches to addressing the issues.”
Nurse practitioners and physician assistants who already have taken the eight-hour MAT waiver course may apply their certificate of completion toward the 24-hour requirement. The eight-hour MAT course is available through Drug Addiction Treatment Act of 2000 (DATA 2000) organizations. Cates-Wessel says her organization had seen “a general uptick” in the number of NPs and PAs taking the waiver course before the passage of CARA.
“We’ve had particularly nurse practitioners and some PAs over the years take the waiver course because they wanted to learn more about it, and the hope was eventually they would be able to prescribe,” Cates-Wessel says.
One DATA 2000 organization that offers the eight-hour MAT waiver course is the American Society of Addiction Medicine (ASAM), which in January announced its own plans to offer education for NPs and PAs to obtain a waiver for prescribing buprenorphine.
Stuart Gitlow, MD, MPH, immediate past president of the ASAM board of directors, says the organization saw an increased demand for training with the passage of CARA. With a significant need for caregivers, Gitlow says such training allows demand to be met more rapidly. Still, he laments the lack of available research to evaluate the quality of care being provided vs. that of physicians.
“Physicians specializing in addiction typically have at least a year of additional training beyond other physicians, and the physicians usually have several years of additional training beyond that of other healthcare professionals,” Gitlow says. “What we don’t know is: Do all those years of training make a difference in terms of what the outcomes are? In some ways, we’ve put the cart before the horse because what we’re saying is we’re going to give the treatment, and then later on, we’ll check to see if outcomes are the same.
“I don’t want to come across as if this is a turf battle. By no means am I implying that, as physicians, our outcomes are going to be better. I don’t know that. It could be that a counselor with no training at all gets better outcomes. We just don’t know.”
Cates-Wessel says that even after completing the 24 hours of training and obtaining the waiver, ongoing education is critical.
“That just starts it because most people in primary care don’t have hardly any training in substance use disorder, much less opioid use disorder or co-occurring mental health disorders,” she says. “It’s a complex situation, so you need support and help.”