What to do if You're Asked to Prescribe Suboxone

As part of an effort to curb our country's opioid crisis, in 2016 former President Obama signed into law the Comprehensive Addiction and Recovery Act. The Act grants nurse practitioners the authority to prescribe buprenorphine (Suboxone) to a limited number of patients upon completion of a training course. As a result, many healthcare employers are now asking nurse practitioners to complete this training and add prescribing Suboxone to the list of services they offer. NPs I talk with have mixed feelings about the issue. 

The reaction I hear from most NPs when it comes to prescribing Suboxone is that they're simply not interested. Many NPs express that they do not have experience managing addiction and feel uncomfortable prescribing the drug. Others have concern that managing addiction invites a different subset of patients into their practice that can be perceived as "difficult". Finally, many nurse practitioners already feel overworked and overwhelmed and don't see the need to expand their patient panel regardless of the reason. Whether you fall into one of these camps or not, there are a few steps to take if your employer asks you to prescribe buprenorphine (Suboxone) as you consider the issue and how it might affect your professional life. 

Step 1: Keep an Open Mind

Even if managing addiction isn't in your clinical wheelhouse and you've never considered adding it as part of your practice, keep an open mind. You may ultimately decide to forgo prescribing Suboxone, but professional opportunities that expand your knowledge base and scope of practice are always worth looking at. So, at least be willing to do some due diligence in the matter. This way, regardless of your decision, you can present an educated standpoint to your employer. 

Step 2: Seek to Understand

Why does your employer want you to prescribe buprenorphine (Suboxone)? Are they looking to serve their current patient panel or looking to expand the practice? Is there a need in the community? The first step in considering the prescribing dilemma is to understand the motivation of your employer. This will help formulate your opinion on the matter and help also position your argument for or against prescribing.

Step 3: Familiarize Yourself with State and Federal Laws

There are specific steps nurse practitioners must take in order to prescribe Suboxone under federal law. Furthermore, states also regulate prescribing. In some states, for example, physician supervision is required in order to prescribe. Lawmakers in three states, Tennessee, Wyoming and Oklahoma, have regulated buprenorphine prescribing above and beyond their usual physician collaboration requirement, expressly prohibited NPs from prescribing buprenorphine (Suboxone) at all. Research the process for nurse practitioners to prescribe Suboxone at the federal level. Understand the rules and regulations for prescribing in your state as well. This way you can stay within professional and legal boundaries if you do choose to prescribe. 

Step 4: Educate Yourself About the Drug 

Discomfort around Suboxone often stems from unfamiliarity with the medication. Educate yourself about buprenorphine best practices. As with any medication, the more you're able to learn, the better decision making skills you will have around it. 

Step 5: Consider Your Current and Future Professional Role

Taking on new patients (although current regulations only allow NPs to prescribe to a limited number of Suboxone users) and adding addiction treatment to the repertoire of conditions you're qualified to treat can have implications for your practice. Think through the logistics of what taking on this additional responsibility and expanding your scope of practice might have. How does this fit with your current workflow? Your future career goals? Your value to an employer? 

Step 6: Ask for a Trial Period

If you aren't 100% sure about prescribing Suboxone but think it would be a valuable service to your patients, you can always ask your employer for a trial period. Once you're appropriately trained you might try seeing Suboxone patients for 6 months or so then chatting with your employer about how things are going. If you are new to addiction medicine you should also make sure you have a mentor who's available to help out when questions arise. 

Do you prescribe Suboxone as a nurse practitioner?

 

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