NPs and PAs: On the Front Lines of the Opioid Crisis


More than 100 people die of opioid overdoses every day in the United States, and the Centers for Disease Control (CDC) estimates the total economic burden of opioid misuse is over 70 billion dollars per year. Healthcare professionals are on the front lines of this crisis. The looming shortage of physicians has required Nurse Practitioners and Physician Assistants to jump in and battle against opioid addiction by providing much needed treatment to patients in recovery.


In 2016, the Comprehensive Addiction and Recovery Act (CARA) was signed into law codifying the ability of NPs and PAs to treat opioid addiction with medications approved for such use. CARA authorizes qualified NPs and PAs to obtain special permission to prescribe Medication Assisted Treatment (MAT) in office‐based settings for patients with opioid use disorder (OUD). This permission is called an “x-waiver” and is obtained through the DEA. Buprenorphine, methadone and natrexone are the medications used in MAT to reduce withdrawal symptoms for patients in treatment. A provider in their first year of providing MAT may do so for 30 patients at one time. After one year, they can apply for an increase to 100 patients, and after a year of managing 100 patients may request an increase to 275. Patients in an MAT program also receive counseling and comprehensive care services that treat the whole patient on their road to recovery.

NPs and PAs may apply for this waiver through the Drug Enforcement Administration (DEA). According to the American Association of Nurse Practitioners (AANP) to qualify NPs and PAs must:

  • Must follow state law regarding the treatment of addiction or OUD
  • Be licensed under state law to prescribe schedule III, IV or V medications for pain
  • Complete no fewer than 24 hours of MAT education provided by an approved organization.  
  • Through other training or experience, demonstrate the ability to treat and manage OUD
  • If required by state law, be supervised or work in collaboration with a physician qualified to prescribe medications for the treatment of OUD


The AANP is one of the organizations qualified to provide the training needed for the DEA x-waiver and is encouraging its members to apply. From June 18–23, 2019, in Indianapolis, Indiana, the AANP will be holding its annual conference. On Tuesday the 18th the conference will offer an 8-hour course on the “ASAM Treatment of Opioid Use Disorder,” which will provide eight of the required 24 hours of education needed for NPs to obtain the waiver to prescribe buprenorphine. 

LeaderStat is proud to be an exhibitor at the AANP conference. Our Locum Tenens NPs take assignments all over the country in all types of healthcare settings and many have cared for patients addicted to opioids. We are pleased that CARA allows them to prescribe needed treatment and happy to work with the AANP to encourage our NPs and PAs to obtain the DEA x-waiver.

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