Abstract
The Drug Addiction Treatment Act of 2000 (DATA 2000) changed addiction treatment in the United States by enabling physicians to treat opioid addiction in settings that do not require specific Federal/State licensure (i.e., physician offices). The legislation (U.S. Dept. of HHS, 2000) requires physicians to complete certification training and obtain a waiver from the Drug Enforcement Agency in order to prescribe and dispense approved opioid medications. In 2002, buprenorphine products (Suboxone® and Subutex®) became the first medications to be approved by the Food and Drug Administration (FDA) for use in office-based opioid treatment.
Office-based opioid treatment (OBOT) is intended to address several needs in accordance with public health objectives, by increasing access to treatment for opioid addiction, offering treatment to patients outside the traditional methadone clinic system, and “mainstreaming” the treatment of opioid addiction by coordinating it with treatment of other medical conditions (Substance Abuse and Mental Health Services Administration—Center for Substance Abuse Treatment [SAMHSA-CSAT], 2001).
Physicians have been slow to adopt OBOT. They are specifically prohibited from delegating buprenorphine prescribing functions to non-physicians. Advanced practice nurses (APNs), nurse practitioners (NPs) and physician assistants (PAs) are not permitted to prescribe buprenorphine, even if they have prescriptive authority in the states in which they practice, despite their interests in prescribing it. This limits the uptake of buprenorphine as a new treatment modality, inhibits the expansion of opioid treatment, and restricts access to buprenorphine by individuals with opioid addiction (Fornili & Burda-Cohee, Citation; Roose, Kunins, Sohler, Elam & Cunningham, Citation).
The Geelhoed-Schouwstra framework is useful in determining whether policy outcomes are likely to be attributed to the policy(ies) of interest, or rather to other exogenous factors that may somehow have influenced those outcomes (Schouwstra & Ellman, Citation). In a previous issue of the Journal of Addictions Nursing, the model was used to explore how extraneous influences may affect implementation of policies and programs that promote treatment integration for individuals with co-occurring psychiatric and addiction problems (Fornili, Citation).
In this column, we examine policies related to the implementation of buprenorphine therapy, and explore various exogenous influences (barriers) that contribute to its underperformance. In particular, we attempt to answer two important questions: Why is it that more waivered physicians are not prescribing buprenorphine? And why is it that nurse prescribers cannot prescribe it?
Exploring these questions from their conceptual, institutional and historical perspectives may promote greater understanding, discussion, and collaboration among clinicians to further enhance access to care for patients in need of treatment for opioid addiction.