Nurse Practitioner Prescribing for Opioid Use Disorder

"The safety and efficacy of nurse prescribing of MOUD is well established, and its expansion can provide a range of advantages to people who are dependent on opiates. This includes increasing access to treatment, but nurse prescribing of MOUD can increase the numbers of people in treatment from ‘hard-to-reach’ cohorts such as those in rural settings, or those with less financial means [19, 34]. This in itself holds a significant potential to reduce a wide range of harms and costs associated with high-risk opiate use [35, 36]. Developing NP of MOUD can also help to create new and innovative treatments which can allow services such as detoxification for complex clients, normally only considered appropriate for in-patient settings, to be delivered in a person’s own home [37]. Where MOUD treatment is already available, it is likely that developing NP will also provide opportunities for enhanced key working and more responsive services [38]. Within England and Scotland, it has been found that the number of non-medical prescribers has grown considerably in the recent past and this has provided an opportunity for nurses particularly in England to work at an advanced level [39].

"The studies included in this review, although mostly from the USA, are reflective of the European context, in that the development of nurse prescribing of MOUD is subject to the efforts made within each jurisdiction to progress it. There are significant variations across regions in terms of levels of training, autonomy and scope of practice and indeed whether nurse prescribing of MOUD happens at all [40]. For example, in the UK, nurses can prescribe MOUD independently, but ‘nurse practitioner’ is not a legally protected title as it is in other regions [41]. In this respect, the already established potential and recognition of the role of NP of MOUD has yet to be realized globally. Recent initiatives such as the ‘safer supply’ policy in British Columbia in Canada provide good examples of how the nursing workforce can provide service users access to range of MOUD treatments including injectable medications [42]. Given the increasing international policy focus placed on expanding access to harm reduction interventions such as methadone, which reduce drug-related deaths [43], it is imperative that initiatives such as NP of MOUD be fully recognised and developed by legislators, policymakers and planners. In this context, there is some guidance available that clarifies the NP role and illustrates the advantages of NP to non-experts [44]. Developing greater international consensus on this, bolstered by more research, and better ‘marketing’ of the NP model would enhance awareness of the advantages of NP of MOUD even further [40].

"To build on current success, the expansion of NP of MOUD also requires ‘whole-systems’ support. In the first instance, this should start with passing the necessary legislation to allow nurse prescribing to take place [16]. Secondly, in order to ensure maximum uptake and to optimise positive impacts on service users, this legislation should allow NPs to prescribe autonomously [12, 23]. Both third-level institutions and healthcare providers also need to collaborate on how to provide the most appropriate institutional training and support, and this should incorporate ongoing education and ‘in-practice’ supervision [45, 46]. Where relevant, this education and supervision should aim to address negative attitudes of non-specialist prescribing nurses towards people who use drugs [47]. More broadly, this should involve delivering addiction education and ‘pro-social’ messaging into the nursing ‘water supply’ at the undergraduate and postgraduate levels [48]. Assurances should also be provided to potential practitioners by properly resourcing ‘joined-up’ services with adequate clinical governance and appropriate input from multi-disciplinary teams which can support practitioners in caring holistically for people with complex needs [49]. These measures should, in turn, increase the uptake of non-specialist nurse prescribers to MOUD treatment and increase the desire for more nurses to specialise in this area."