Page 1 of 1

Posted: Fri Jul 15, 2016 9:18 am
by jmosby1469
Very, very well said!!

Posted: Fri Jul 15, 2016 9:18 am
by peterorrin
CT law freeing NP/APRNs from direct supervision causes concern here because practicing high quality addiction medicine is difficult, complicated, and it takes a long time to 'get good' at it. CT law could be changed to require NP/APRNs, for a specified period, to practice MAT medicine with certified docs; or, the elements of high quality MAT could be required of mid-level health providers.

As for pill mills, they are more a matter of provider character & values than of academic degrees.

We also need to keep in mind that in many places, Medicaid OUD patients face a 'buprenorphine desert'...most independent waivered doctors do not provide MAT care for this population. Hopefully, waivered midlevel providers will help meet that need.

Peter Rostenberg


Posted: Fri Jul 15, 2016 9:18 am
by MChaplin
Nurses and PA s will have to take a 24 hour training course- docs still only need the 8 hour one. So there are restrictions on both groups and docs have less.

Posted: Fri Jul 15, 2016 9:18 am
by NoDrugs4u
My view is this, until now the 'powers that be' didn't even think all physicians were qualifed to prescribe bup without special certification, but now all of a sudden any nurse with extra letters after his/her name is now qualified to treat addiction!

And, yes, I agree that there are some irresponsible MD/DO's, but now with pseudo-doctors in the mix there will be exponentially more irresponsible prescribers.

Posted: Fri Jul 15, 2016 9:18 am
by kcairns
Unconsciooutnable that when choice for severe chronic pain comes to be between full vs partial agonists that rulers push it to the common tremendous harms of full

Posted: Fri Jul 15, 2016 9:18 am
by Bruni
It is not just NPs/PAs who overprescribe. Ms Xyz, 76 yrs old, with very long history of migraines, was getting 180 doses of oxycodone regularly each month (and running out early) from the neurologist (MD) and 240 doses each month (regularly) of butalbital from the MD/NP in primary care; both scripts were continuous for more than a year. She is now on bupe 4mg/d and valium 10mg/d (tapering off barbs). Her drug overuse headaches are much better. She is happier.
There are irresponsible NPs/PAs/MDs but it looks like a problem inherent in our current care delivery system from my point of view.

Posted: Fri Jul 15, 2016 9:18 am
by bandalier
So let me get this straight
Individuals i.e. NPs and PAs - who have never had critical training in actually making an individual decision in the workup and treatment of a patient will now be prescribing MAT ?
Wonderful !
As a matter of fact I now already treating the excess of local NPs whether it's pain medication or Benzo which they seem to prescribe like candy.
What genus thought that was a good idea ?

Posted: Fri Jul 15, 2016 9:18 am
by MChaplin
APRN's are no longer subject to any MD supervision in Connecticut- so once they complete the 24hour training to obtain the waiver, they will prescribe buprenorphine just as MD's do. I am not sure why this would cause pill-mills- presumably they will be limited to 30 then 100 and since there is no fellowship level training for nurses they can't go to 275 without being part of a "program"- seems to me that if these APRN's were interested in becoming pill mill people, they would stick to pure agonists where they can "treat" as many people as they can squeeze into the office without the provision of an unannounced DEA visit every 5 years hanging over their heads.....APRN's in CT can prescibe full agonists without any additional training or supervision or limitations- to me that is much more dangerous than letting them prescribe buprenorphine- AND in my opinion, lots of MDs are not interested in prescribing buprenorphine especially to the medicaid population-here in CT we are still in a situation where need - exceeds demand. If this goes through will there be some bad/dangerous prescribing ? for sure, BUT it is possible that the good may outweigh the bad.

Posted: Fri Jul 15, 2016 9:18 am
by robertsonjon
Ok, so, I'm sticking with the previous limit of 100, but I could get a NP practicing under me who could get the same 100 pt limit?

As long as I'm overseeing their work, it could be a good thing for the community where I practice.

Posted: Fri Jul 15, 2016 9:18 am
by NoDrugs4u
"Expands prescribing privileges to nurse practitioners" --> LET THE PILL-MILLS BEGIN.....