--- title: The Overlooked Potential Solution to the U.S. Opioid Crisis description: Empowering nurses could solve the U.S. opioid crisis, argue Tommy Thompson, former Secretary of Health, and David Hebert, CEO of the AANP. canonical: https://time.com/5612549/opioid-crisis-nurses/ author: David Hebert article:opinion: true article:content_tier: free article:published_time: 2019-06-24T13:00:40.000Z article:modified_time: 2026-08-04T08:06:32.129Z article:section: Ideas og:title: The Overlooked Potential Solution to the U.S. Opioid Crisis og:description: Empowering nurses could solve the U.S. opioid crisis, argue Tommy Thompson, former Secretary of Health, and David Hebert, CEO of the AANP. og:url: https://time.com/5612549/opioid-crisis-nurses/ og:site_name: TIME og:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt31c2d8b3586659eb/6989ff007cdbac2722d60e2d/nurse-methadone-clinic.jpg?branch=production&width=1024&quality=75&auto=webp&crop=16:9 og:image:width: 1024 og:image:height: 576 og:image:alt: Role of nurses in solving the opioid crisis og:type: article twitter:card: summary_large_image twitter:title: The Overlooked Potential Solution to the U.S. Opioid Crisis twitter:description: Empowering nurses could solve the U.S. opioid crisis, argue Tommy Thompson, former Secretary of Health, and David Hebert, CEO of the AANP. twitter:image: https://static.time.com/v3/assets/bltea6093859af6183b/blt31c2d8b3586659eb/6989ff007cdbac2722d60e2d/nurse-methadone-clinic.jpg?branch=production&width=1024&quality=75&auto=webp&crop=16:9 ---  # One Possible Solution to the Opioid Crisis in the U.S. Has Been Inexplicably Ignored > Sponsored content. 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Chris McGreal, author of "American Overdose," told TIME how the American opioid epidemic is a result of corporate greed._ by [David Hebert](https://time.com/author/david-hebert/) and [Tommy Thompson](https://time.com/author/tommy-thompson/) Jun 24, 2019 1:00 PM UTC  A nurse prepares a dose of methadone in Lisbon, Portugal, on Oct. 4, 2017\. The daily methadone program is part of Portugal new emphasis on treating drug addiction with a public health approach. A nurse prepares a dose of methadone in Lisbon, Portugal, on Oct. 4, 2017\. The daily methadone program is part of Portugal new emphasis on treating drug addiction with a public health approach. Horacio Villalobos—Corbis/Getty Images by [David Hebert](https://time.com/author/david-hebert/) and [Tommy Thompson](https://time.com/author/tommy-thompson/) Jun 24, 2019 1:00 PM UTC The President’s Council of Economic Advisors (CEA) just released a new report on [how to beat back America’s opioid crisis](https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf). The CEA highlighted as potential solutions measures like curbing illicit drug trafficking, reducing over-prescribing in doctors’ offices, and cracking down on drug distributors fueling the epidemic for profit. Those are noble goals, to be sure. But the CEA report lacks one crucial element in fighting this crisis: nurse practitioners. About 72,000 Americans died from a drug overdose last year, according to data from the Centers for Disease Control and Prevention. Over two-thirds of those deaths were from opioids. To put that in perspective, drug overdoses killed almost the same number of Americans last year as car crashes and guns—combined. Primary care professionals are on the front lines of the opioid epidemic. And thanks to advances in “Medication-Assisted Treatment”—which combines medications that temper cravings, like methadone and buprenorphine, with counseling and therapy—they’re better equipped to treat dependence than ever before. But the U.S. is suffering from a severe shortage of primary care professionals; a whopping [80 million](https://data.hrsa.gov/topics/health-workforce/shortage-areas) Americans lack adequate access to primary care. The shortage is particularly bad in rural areas, where patients are “almost five times as likely to live in a county with a primary care physician shortage compared to urban and suburban residents,” according to a [2018 UnitedHealth Group report](https://www.unitedhealthgroup.com/content/dam/UHG/PDF/2018/UHG-Primary-Care-Report-2018.pdf). This presents a serious problem for those seeking substance-abuse treatment. Without access to primary care professionals, addicted patients struggle to receive the care they need. Right now, nearly 80% of Americans addicted to opioids aren’t receiving treatment. Empowering nurse practitioners to treat addiction—and removing unnecessary restrictions at the state level—can go a long way in liberating American patients. Nurse practitioners, or NPs, are well positioned to help patients get the care they deserve. Equipped with graduate degrees and advanced clinical training, NPs are qualified to assess patients, order and interpret diagnostic tests, develop treatment plans, and prescribe medications in all 50 states. [Studies have shown](https://www.aanp.org/advocacy/advocacy-resource/position-statements/quality-of-nurse-practitioner-practice) that NPs provide care that’s just as good as—and [sometimes better than](https://www.npjournal.org/article/S1555-4155%2813%2900410-8/abstract)—physicians. According to a recent study in the journal [_Medical Care_](https://journals.lww.com/lww-medicalcare/Fulltext/2018/06000/Quality%5Fof%5FPrimary%5FCare%5FProvided%5Fto%5FMedicare.5.aspx), Medicare beneficiaries treated by NPs had lower rates of preventable hospital admissions, hospital readmissions, and inappropriate emergency-room visits than those treated by physicians. Between 2016 and 2030, the number of NPs in the workforce is projected to grow by [6.8% annually](https://www.aei.org/wp-content/uploads/2018/09/Nurse-practitioners.pdf), according to a [study from Peter Buerhaus](https://www.aei.org/wp-content/uploads/2018/09/Nurse-practitioners.pdf) a healthcare economist and professor of nursing at Montana State University. The report also found that these NPs will be far more likely to practice in rural and underserved regions, But dozens of states unnecessarily limit where and how NPs can practice. For instance, many states require NPs to sign elaborate “collaborative agreements” with physicians. These agreements reduce primary care options by limiting how and where NPs can practice. Some states will subject NPs to career-long supervision, delegation, and management—all to enable NPs to perform activities for which they are already [well-trained](https://www.aanp.org/advocacy/state/state-practice-environment). Collaborative agreements can also thwart efforts to offer care in rural areas. Some states, like Mississippi, require NPs to practice within a certain number of miles of their collaborating physician. In addition, these agreements sometimes disrupt patient care. In Missouri, NPs can only prescribe limited quantities—and certain types—of medications. Further, while NPs in 28 states can complete training and receive a waiver to prescribe Medication-Assisted Treatment, _t_hey can only utilize it if their [collaborating physician](https://www.asam.org/docs/default-source/education-docs/cara-language-on-qualifying-physicians.pdf?sfvrsn=26427ec2%5F2) is [also qualified](https://pcssnow.org/medication-assisted-treatment/waiver-training-for-nps/faqs/) to apply for one. In many cases, NPs have found it difficult to identify a physician who meets one or more of the [required criteria](https://www.asam.org/docs/default-source/education-docs/cara-language-on-qualifying-physicians.pdf?sfvrsn=26427ec2%5F2)—such as having addiction certification from the American Society of Addiction Medicine or having served as an investigator on an approved narcotic’s clinical trial—to be a “qualifying physician.” This ultimately restricts their patients’ access to critical addiction treatments. These restrictions don’t just impact Medication-Assisted Treatment prescribing, they deter NPs from practicing at all. In fact, states with laws that limit NPs’ scope of practice have [40% fewer NPs](https://www.aei.org/wp-content/uploads/2018/09/Nurse-practitioners.pdf) per capita than states without. That’s why they make so little sense—particularly in states where the opioid epidemic is especially dire. Federal lawmakers have demonstrated that they’re serious about ending the opioid epidemic. State lawmakers can show they’re serious by allowing NPs to do their jobs. **Correction:** A previous version of this article implied that Peter Buerhaus worked for the D.C.-based conservative think tank American Enterprise Institute (AEI). In fact, Buerhaus was (and still is) affiliated with Montana State University, and was a contributor to a report published by AEI. ## Transcript 85 % of the world's presrciption opioids are consumed in the United States, which is 5 % of the world's population. And you think how does one country come to be so dependent on these drugs? It is not that the United States has 85 % of the world's pain. Health in this country Is an industry, it's a medical industry. In most other countries, it's a public health service. There's money to be made. [ MUSIC ] I started this story really where the epidemic begins, which is in that little part of Upper Asia where these drugs first take off. In a lot of these communities, people are already using low level opioids. And then this drug comes along called Oxycontin. And it's 10, 15, 20 times the power of the origin drugs. This drug is so throughout the country but targeting these marginalized communities. And by sales force by Purdue Pharma that went out with essentially junk science. They pushed papers across to doctors making claims about addictiveness and they persuaded the Food and Drug Administration to endorse those claims on the label of The pills and these drugs spread very, very quickly. The demand for them rises because firstly they're seen as more effective. But also the circle of people who become dependent and then addicted to them widens very, very quickly. And people want more and more of them. And the drug companies are willing to sell them more and more. And one of the myths that was sold along with all of this was there was no upper limit to taking these drugs. That you Wouldn't become addicted, provided you're in pain. These drugs, which I repeat, are our best, strongest pain medications, should be used much more than they are for patients in pain. People kept taking escalating doses for what they thought was dealing with pain. But, in fact, it was withdrawal symptoms, if they'd cut back. And this created a massive market. By 2012, you have doctors in this country writing 250 million prescriptions a year for opioid pain medicines, which is effectively one for every adult in the country. We're 20 years into this epidemic, and there are now A lot of lawsuits, particularly, by states attorney generals and individual cities against both the drug makers, and the drug distributors, and in some cases, the pharmacy, and even the doctors. There's plenty of doctors that have been locked up, but there hasn't been a single executive, not a single one, has gone to prison for this. The US still prescribes at three, four, five times the rate of most European countries, for instance. So if you're not gonna have another generation who are open to addiction, there's gotta be a much tighter grip on prescribing. And there are people who genuinely need these drugs, but they're not 190 million people in a country of 360 million people. 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