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Could Expanding Nurse’s Scope of Care Help Fight the Opioid Epidemic in California?

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A bottle of the prescription pain medication buprenorphine. It is one drug used to treat people with opioid use disorder. (Joe Raedle/Getty Images)

When it comes to treating opioid addiction, most health care experts say nurses have a critical role to play in prescribing the lifesaving medication buprenorphine.

Buprenorphine can be prescribed by both doctors and nurses who have taken specific training and received a license from the Drug Enforcement Administration.

In California, however, the role of nurses is limited: They can prescribe the medicine, but only under the oversight of a doctor. That requirement is controversial. Some say it is an extra hurdle that restricts access to medications, while others say it is an appropriate limit of a nurse's scope of care.

A study published in the medical journal JAMA in April found that states without a physician-oversight requirement to prescribe buprenorphine have more nurses getting licensed to distribute the medication — 75% more than nurse practitioners in states with the restriction.


"An important part of addressing the opioid crisis is helping people access treatment when they need it," said Joanne Spetz, associate director of research at UCSF’s Healthforce Center, who co-authored the study.

And nurses play a big role in that.

"There are numerous studies that show that the quality of nurse practitioner care for primary care and for the areas in which they are trained and prepared is as good as a physician," Spetz said.

More Coverage of the Opioid Crisis

More than 47,000 people died from an opioid overdose nationwide in 2017, according to the most recent data. The gold standard for treating this addiction is medication and counseling. Yet the majority of the roughly 2 million people with opioid addiction cannot access these medications, like buprenorphine.

California is the only Western state with this doctor supervision requirement as it applies to buprenorphine.

Assemblyman Jim Wood authored a bill that would authorize a nationally certified nurse practitioner to provide specific medical services without physician oversight, including prescribing buprenorphine.

Wood represents counties in the northwest part of the state, where opioid overdose death rates are higher than the national average.

Some of the rural counties Wood represents have a dearth of health care providers.

"We’ve had primary care shortages, and over the last seven or eight years it’s actually gotten worse," Wood said.

He sees nurse practitioners as an important way to fill that gap: "We need that workforce."

Wood's bill follows recommendations made by the California Future Health Workforce Commission, a group of experts in the fields of health, labor and education. The coalition released a report in February highlighting a mismatch between the state's health care needs, and both the supply and type of health care workers available.

The report predicts California will be short more than 4,000 doctors in the next decade. One of the group's suggestions to address the deficiency in primary care? Expand the authority of nurse practitioners.

But Dr. David Aizuss, president of the California Medical Association, said the legislation was not the way to plug that gap.

"There’s no doubt in my mind that nurse practitioners have a role as part of team-based medical care for providing care for patients," he said. "What we don’t support is sending nurse practitioners out into individual communities, opening up storefronts to practice essentially independent medicine, when they’re not trained for that."

Aizuss said his group has worked on other solutions to the rural health care shortage, like creating more positions for primary care residents in California, and loan forgiveness programs for doctors who work with high numbers of low-income patients who rely on Medi-Cal.

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