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2 Ways to Make Progress Against the Opioid Epidemic

It’s killing tens of thousands of Americans every year. Expanding access to highly effective medication-assisted treatment and empowering nurse practitioners to provide primary care are key to meeting the challenge.

(Dan Gleiter, PennLive/TNS)
Headlines of the last two years have been dominated by the global pandemic, yet COVID-19 is not the only deadly health crisis we are facing. The U.S. opioid epidemic, already at severe levels before COVID-19, has reached new heights at a time when our health-care system, stretched thin by the pandemic, is also at risk. States need to expand access to the health-care providers and services patients need, and nurse practitioners are the linchpin of that effort.

Before the pandemic, the U.S. Centers for Disease Control and Prevention estimated that between 1999 and 2019 nearly 500,000 people in the U.S. died from an overdose involving opioids. For the 12 months ending in April 2021, provisional results from the CDC’s National Center for Health Statistics show 75,673 opioid-related overdose deaths, a jump of nearly 35 percent from the previous 12-month period. The increase is largely attributed to the synthetic opioid fentanyl, and according to the National Institutes of Health, the fentanyl most frequently associated with recent overdoses is produced illegally.

As the opioid epidemic rages on and the country enters its third year of the COVID-19 pandemic, states are struggling to manage these coexisting health crises that threaten to overwhelm many of the public services they provide. To meet the opioid challenge, states should increase access to medication-assisted treatment (MAT). Prescribed by primary health-care providers, MAT uses medications, combined with counseling and therapy, to prevent overdose and reduce drug cravings. These plans are typically highly effective, but many patients with opioid use disorder do not have adequate access to health-care providers. Sadly, 80 percent of Americans with opioid use disorder aren’t receiving treatment.

One reason is that the COVID-19 pandemic is stretching our health-care system and workers to their limits and forcing many patients to delay seeking care for preventive needs and other non-COVID-19 health concerns. The greatest factor affecting access to treatment may be the severe shortage of primary care providers.

According to the U.S. Department of Health and Human Services, 89 million people live in one of the nation’s 7,694 primary care health professional shortage areas and 142 million live in one of the 6,127 mental health professional shortage areas. This lack of adequate access translates to limited or no preventive care, screenings, immunizations or basic care for infections and illness.

One way states can ensure better access to treatment is to empower highly trained and clinically educated nurse practitioners (NPs). With more than 325,000 NPs now licensed in the U.S. and approximately 30,000 new NPs entering the health-care workforce every year, they are, for millions of Americans, the primary care providers of the present and future.

Unfortunately for patients, access to MAT therapy isn't equitable across all states, and although NPs provide health-care services across the country, their ability to do so is not equal in all areas. In 24 states, along with two U.S. territories and the District of Columbia, patients have full and direct access to NPs thanks to the adoption of full practice authority legislation. In the remaining states, outdated licensure laws prevent patients from directly accessing NP-delivered care, which limits their access to MAT treatment.

States that saw the highest proportion of nurse practitioners prescribing MAT are those where patients are provided full and direct access to NPs. By contrast, 11 of the 12 states with the fewest number of NPs obtaining waivers to prescribe MAT are states without full practice authority.

Given the urgent need to strengthen primary health-care access amidst this dual health-care crisis, states need to permanently modernize licensure laws and empower NPs to reach and treat more patients suffering from opioid use disorder. NPs are key allies in the movement for better health outcomes. States should ensure that all patients, including those with opioid use disorders, can access the high-quality care NPs deliver.

April N. Kapu, a nurse practitioner who holds a doctorate in nursing practice, is president of the American Association of Nurse Practitioners. Follow her on Twitter at @PresidentAANP.

Governing's opinion columns reflect the views of their authors and not necessarily those of Governing's editors or management.
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