There is a national effort to expand access to medication-assisted treatment with buprenorphine products. In fact, HHS has just extended permission to prescribe MAT products to some nurse practitioners and nurse midwives, among others. But if we do not also expand access to well-rounded rehabilitative care and services, we could be ignoring essential guidelines on recovery published by the Substance Abuse and Mental Health Services Administration.

In January 2021, the Department of Health and Human Services published a new document, “Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder.” 

This document opens the door to more types of medical practitioners having permission to prescribe medication-assisted treatment (MAT) drugs containing buprenorphine. 

As of April 2021, the list of practitioners allowed to prescribe buprenorphine products to opioid-addicted individuals included:

  • Physicians
  • Physician assistants
  • Nurse practitioners
  • Clinical nurse specialists
  • Certified registered nurse anesthetists
  • Certified nurse midwives

If they are already registered with the Drug Enforcement Administration and have the right to prescribe opioids as part of their practice, they were able to prescribe buprenorphine formulas for the purpose of addiction treatment starting in April.

Bottle of buprenorphine/naloxone.

Photo by Tmeers91.

The HHS document notes that in some states, physician assistants and the various types of nurses will need to work in collaboration with a DEA-registered doctor. Practitioners like Advanced Practice Registered Nurses will only need to complete an eight-hour online training course to be able to start prescribing buprenorphine to those addicted to opioids. 

While there are some positive aspects to getting an opioid-addicted person onto a controlled dosage of an opioid to protect them from a marketplace full of fentanyl, what other support will these individuals receive? Will these APRN’s be able to enroll their patients in life skills training to restore the fundamental skills they need to make the right choices and cope with changes and setbacks? Will physicians assistants have any access to well-rounded rehabilitative care for their patients? Will there be counseling available in sufficient quantity and quality for each person in recovery?

There is such an effort to expand access to medication-assisted treatment but far less of an effort to improve access to true, well-rounded rehabilitation. 

Guidelines from SAMHSA

In contrast, the Substance Abuse and Mental Health Services Administration (SAMHSA) has established guidelines for what rehabilitation really means, whether it’s rehabilitation from emotional and mental problems or rehabilitation from addiction. 

In 2010, this agency authored a booklet titled, Working Definition of Recovery. Included in the booklet are “10 Guiding Principles of Recovery.” Briefly, these ten points are:

  1. Recovery emerges from hope 
  2. Recovery is person-driven
  3. Recovery occurs via many pathways
  4. Recovery is holistic
  5. Recovery is supported by peers and allies
  6. Recovery is supported through relationship and social networks 
  7. Recovery is culturally-based and influenced
  8. Recovery is supported by addressing trauma
  9. Recovery involves individual, family, and community strengths and responsibility 
  10. Recovery is based on respect

Under the heading “Recovery is holistic,” the SAMHSA guide states: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. This includes addressing: self-care practices, family, housing, employment, transportation, education, clinical treatment for mental disorders and substance use disorders, services and supports, primary healthcare, dental care, complementary and alternative services, faith, spirituality, creativity, social networks, and community participation. The array of services and supports available should be integrated and coordinated.

Addiction is traumatic. An addicted person loses their self-respect, their moral compass. Their health may be damaged. Their relationships have suffered. They may have watched people die right in front of them. They have probably lost friends and even loved ones to overdoses. That’s a lot to recover from, in addition to the person’s own dependence on addictive substances. They need all these features of recovery to rebuild their life. 

The HHS has decreed that nurse midwives and physicians who are only qualified by being registered with the DEA can begin prescribing buprenorphine products. Is it possible that this rush to expand access to buprenorphine could result in overlooking all the other ways each addicted person needs to be cared for?

SAMHSA has provided an excellent guide for the care of those who have become addicted. Admittedly, it is much harder to assist a person in recovering in “mind, body, spirit and community” than it is to prescribe buprenorphine. If we only focus on a rush to expand the administration of MAT to those addicted to opioids, we might miss the well-rounded care these individuals truly need so desperately.





Image of buprenorphine bottle: Tmeers91, CC BY-SA 3.0 <https://creativecommons.org/licenses/by-sa/3.0>, via Wikimedia Commons