A sought-after medication used to wean addicts off heroin and other opioids can now be prescribed by nurse practitioners and physician assistants, as well as doctors, in New York state.
The state’s addition of medical practitioners who can prescribe buprenorphine, known by the brand Suboxone, is an attempt to increase access to the medication amid the heroin and opioid abuse epidemic. It’s the latest effort to make medication-assisted treatment for addiction more widely available.
A once controversial therapy, it’s become more widely accepted in light of rising overdose deaths and improved understanding of addiction as a medical disorder affecting brain chemistry.
“We hope and expect that the addition of NPs and PAs will increase access,” said Stephanie Campbell, executive director of Friends of Recovery New York.
Nurse practitioners and physician assistants joined the list of practitioners who can prescribe buprenorphine in May, says the state Health Department. Rules covering their participation were published this week in the New York State Register. All practitioners who want to prescribe the medication must go through a training course and are subject to limits on how many patients they may have on the drug.
Buprenorphine is one of several medications used to help addicts give up opioids, whether they are abusing prescription painkillers like oxycodone or illegal drugs like heroin. Like methadone, it is a highly regulated substance whose ingredients include an opioid. It can help someone slowly kick an opioid addiction.
Unlike methadone, which may be dispensed only at a federally approved clinic, buprenorphine can be ordered by a medical practitioner and picked up at the pharmacy, like most other prescription drugs.
But recovering addicts and their families have told the Times Union about challenges in finding ethical providers who will prescribe buprenorphine, especially those who will take insurance rather than cash. A couple of years ago, they reported it was easier to get Suboxone on the street than in a doctor’s office.
Since then, federal health officials have urged opening up access to medication assisted therapy, and have expanded the number of patients that doctors may monitor, from 100 to 275 patients. (The new rule will allow nurse practitioners and physician assistants to prescribe to 30 patients initially, and then increase to 100.) The state Office of Alcoholism and Substance Abuse has approved more clinics that dispense both methadone and buprenorphine, as well as a third drug, naltrexone, known as Vivitrol.
Lisa Wickens-Alteri, a Guilderland resident and patient advocate who speaks publicly about her son’s struggle with addiction, praised the state’s efforts to increase medication-assisted treatment at clinics. But it remains difficult to get Suboxone at a medical office, she said. She recently contacted a large regional medical office with more than 100 providers and found that only one practitioner there was prescribing buprenorphine.
Many middle class people who could benefit from the medications won’t go to a clinic to get them, she said. “Who’s going to go to Whitney Young if they’re going to Bethlehem High School, to get treatment?” Wickens-Alteri said, referring to the methadone clinic on DeWitt Street, between rail tracks and the river. “There’s still that stigma.”
Doctors who prescribe buprenorphine in private practices, outside of addiction treatment centers, have said several factors keep their peers from also doing so. Monitoring patients on the drugs carries added responsibilities, and improper supervision can result in suspension of a medical license if a patient sells Suboxone on the street.