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HealthConnections - Removing Barriers to Treatment of People with Substance Abuse Disorders

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Dr. Carole Myers: Welcome to Health Connections. The show about people health and policy. I'm Dr Carol Myers. Every day, at least three Tennesseans die from opioid related overdoses. This number is greater than the number of people who die in motor vehicle accidents. Despite this, Tennessee is an outlier in the availability of treatment for substance abuse disorders today, nurse practitioner Meg Gill will help us discern the untoward impact of Tennessee's overly restricted regulations and what can be done to get people the help they need. Meg Gill, Welcome to Health Connections.

Meg Gill: Thank you so much.

Please share a bit about your clinical practice at choice health network and the people that you serve.

Sure, choice health network is part of positively living, which is an organization that was founded decades ago for people living with HIV, and that was really in the time when HIV had no good treatment. We're just far beyond that now, but people living with it still need help. Definitely need medication. And one thing we're seeing here in our region is that now HIV is mainly transmitted by IV drug use. It's no longer as commonly transmitted through sexual means, but because people are using IV drugs like fentanyl, heroin, and moving off of that, other street drugs,

These people are using IV drugs, and therefore are at risk. How do we address your clients that are using IV drugs?

We have a harm reduction department, and that helps people acquire safe supplies. So that's kind of one, one way that you address it, but another way is looking at the substance use disorder, and we can treat that in many ways as well. Buprenorphine that you introduced before is one of the ways that's a medication that is a partial opioid agonist, and people can take it in order to stave off cravings for opioids or to help them with the withdrawal symptoms when they are stopping using opioids. We want to switch people to buprenorphine. It's a much safer substance, a much safer medication than anything they're using off the street.

Yes, understand it's not just safe, it's also effective.

Yes, it's a safe and effective way for people to have their opioid use disorder treated.

So I understand from prior conversations we've had that nurse practitioners in Tennessee, the majority of them, are unable to prescribe buprenorphine

In Tennessee, if you work in a specific kind of clinic, and that would be a clinic geared towards treating opioid use disorder, or in a clinic that's a federally qualified health center, you can, as a nurse practitioner, prescribe buprenorphine, however, if you're in another kind of clinic, so if it doesn't fall under those two umbrella terms, you can't prescribe buprenorphine, even though, as a nurse practitioner, you could prescribe, for instance, oxycodone. We are licensed and capable of prescribing opioids, but we're not licensed to prescribe the medications that allow us to treat opioid use disorder. So in my clinic, for instance, because we don't fall into one of those categories, we provide infectious disease and primary care, my collaborative physician would have to prescribe buprenorphine to my patients.

What sort of barriers does that pose for you in your practice?

It's a pretty solid barrier for us. My collaborative physician is not on site, and so what happens when you prescribe buprenorphine? A patient needs to come in already withdrawing from opioids, we're already sort of on a countdown of how long they can manage being in withdrawal. And with opioid use disorder, as with anything else, there's sort of a window of motivation, a window of opportunity when people are willing to try to make change in their behavior.

Meg, what needs to change when you have this patient before you who is motivated towards treating their substance use disorder, what needs to happen, that's not happening.

It would be so much simpler if nurse practitioners could prescribe buprenorphine. That would be the thing. That's the missing link here. We know that buprenorphine works. We know it's an effective therapy. We should be able to prescribe it. We can prescribe medications in the same class. This is a protective measure. So really that would be the key nurse practitioners being able to prescribe buprenorphine.

This transcript has been lightly edited for content.

Greg joined WUOT in 2007. He started in public radio in 2000 in Shreveport, La., at Red River Radio and was, prior to coming WUOT, at WYSO in Dayton, Ohio.