July 13, 2016

Over the past year, AAPA aggressively lobbied for PAs to be part of the solution to the nation’s opioid epidemic. As a result of our efforts, PAs will soon be eligible to become waivered to prescribe buprenorphine for the treatment of opioid addiction. On July 8, the U.S. House of Representatives overwhelmingly supported passage of the House-Senate Conference report to S. 524, the Comprehensive Addiction and Recovery Act (CARA) of 2016 and the U.S. Senate followed suit on July 13. The legislation amends federal law (the Drug Addiction Treatment Act of 2000 orDATA 2000) to permit PAs to become waivered to prescribe buprenorphine for the treatment of opioid addiction.  It will now be sent to the president for his expected signature.

“As a PA with a background in addiction medicine and community health clinics, I am pleased Congress is bringing more resources to bear to tackle the opioid addiction crisis in this country," said AAPA President Josanne Pagel. “The inclusion of PAs in CARA is crucial to our ability to provide proven treatment options to more Americans suffering from addiction.”

Although CARA was crafted in a bipartisan manner, funding was a contentious issue leading up to the bill’s passage and shaped many of the bill’s final provisions. This was because the Congressional Budget Office gave the bill a high cost estimate for the Medication-Assisted Treatment (MAT) Program, Section 303, of the bill. This unexpectedly high cost ultimately determined the conditions in which DATA 2000 was amended to permit PAs and nurse practitioners (NPs) to become waivered to prescribe buprenorphine for the treatment of opioid addiction. The final version of the Section 303 MAT Program:

• Authorizes PAs and NPs to become waivered to prescribe buprenorphine in MAT for a five-year period, expiring in 2021;
• Allows newly-waivered PAs, NPs, and physicians to prescribe buprenorphine to 30 patients, with the option to treat up to 100 patients after one year if certain conditions are met;
• Requires PAs and NPs to obtain 24 hours in education related to the treatment of opioid addiction as a condition to be waivered; the law includes AAPA in the list of professional associations who may provide the educational requirements; additionally, the law provides the secretary of the Department of Health and Human Services (HHS) the flexibility to adjust the 24-hour educational requirement for clinicians with demonstrated experience in treating patients struggling with addiction;
• Defers to state law regarding whether a PA or NP works with a physician through a supervisory or collaborative relationship; however, the legislation requires that a physician who supervises or collaborates with a PA or NP must also be waivered to prescribe buprenorphine to treat addiction; given the small number of waivered-physicians, particularly in rural and other medically underserved communities, AAPA is concerned this requirement will limit the number of PAs and NPs who will become waivered; fortunately, there is also a provision in the bill that provides flexibility to the HHS Secretary to review and remove the requirement.

According to Tillie Fowler, AAPA’s senior vice president for advocacy and government relations, “Although Section 303 of CARA does not include all of AAPA’s policy recommendations; we believe it is a significant step forward in utilizing PAs to expand access to treatment for the millions of Americans who are struggling with opioid addiction. And AAPA will push to extend this authorization for PAs beyond its current 2021 expiration date.”

In addition to MAT, CARA contains numerous programs and provisions designed to:

• Support and provide grants for education, prevention, treatment, and recovery efforts to confront the opioid epidemic and assist individuals and communities suffering from addiction to opioids and heroin;
• Provide grants to expand access to naloxone and prescription drug monitoring programs and to support veterans and law enforcement.

Enactment of CARA is a significant win in AAPA’s continued efforts to ensure PAs have the ability to be part of the solution to the nation’s opioid epidemic. The Academy presented multiple statements and letters to Congress on the need to permit PAs to prescribe buprenorphine for the treatment of opioid addiction; extensively lobbied committee staff and members, as well as House and Senate leadership; and held joint lobbying visits with the American Association of Nurse Practitioners. AAPA will continue its work through the development of regulations to implement the MAT Program.

- See more at: https://www.aapa.org/twocolumn.aspx?id=6442451389#sthash.Ev0XpXcU.hDmrNspU.dpuf