HEALTHCARE PROVIDERS LICENSED TO PRESCRIBE BUPRENORPHINE FOR ANY FDA-APPROVED USE IN RECOVERY OR MEDICATION-ASSISTED TREATMENT
Under present law, a physician licensed under state law is the only healthcare provider authorized to prescribe any buprenorphine product for any FDA-approved use in recovery or medication-assisted treatment, except for a healthcare provider not licensed as a physician who is otherwise permitted to prescribe Schedule II or III drugs and who meets other qualifications under state law relative to use of buprenorphine products.
This bill authorizes a nurse or physician assistant employed by or contracted with a nonresidential office-based opiate treatment facility, or employed by a hospital or an affiliated clinic operating under the hospital's license, to prescribe a buprenorphine product as approved by the FDA for use in recovery or medication-assisted treatment if they meet other qualifications under state law relative to use of buprenorphine products.
PROVIDERS WHO ARE NOT LICENSED PHYSICIANS BUT ARE OTHERWISE PERMITTED TO PRESCRIBE SCHEDULE II OR III DRUGS
Under present law, one requirement for a healthcare provider who is not a licensed physician but is otherwise permitted to prescribe Schedule II or III drugs, to be authorized to prescribe buprenorphine for the treatment of opioid use disorder, is that they be employed by a community mental health center or a federally qualified health center that employs one or more physicians and has adopted clinical protocols for medication-assisted treatment.
This bill adds to this qualification that such a healthcare provider may prescribe buprenorphine for the treatment of opioid use disorder if the provider is employed by a hospital or an affiliated clinic operated under the hospital's license.
PROVIDERS WHO ARE NURSES OR PHYSICIAN ASSISTANTS
Under present law, two of the requirements for a nurse or physician assistant employed by or contracted with a nonresidential office-based opiate treatment facility to be authorized to prescribe buprenorphine products as approved by the FDA for use in recovery or medication-assisted treatment are as follows:
(1) The provider works in a nonresidential office-based opiate treatment facility that is licensed by the department of mental health and substance abuse services and that does not have authority to dispense buprenorphine products; and
(2) The provider practices under the direct supervision of a licensed physician who holds an active Drug Addiction Treatment Act of 2000 (DATA 2000) waiver from the United States drug enforcement administration and is actively treating patients with buprenorphine products for recovery or medication-assisted treatment at the same nonresidential office-based opiate treatment facility as the provider.
This bill authorizes a nurse or physician assistant who works in a hospital or an affiliated clinic operated under the hospital's license to also prescribe a buprenorphine product as approved by the FDA for use in recovery or medication-assisted treatment.
Under present law, a nurse or physician assistant who is employed by or contracted with a nonresidential office-based opiate treatment facility, in order to prescribe buprenorphine products for use in recovery or medication-assisted treatment must prescribe buprenorphine products only to patients who are treated through a nonresidential office-based opiate treatment facility that employs or is contracted with the nurse or physician assistant.
This bill changes the above provision so that it only applies if the nurse or physician assistant works at a nonresidential office-based opiate treatment facility, as this bill authorizes a nurse or physician assistant working at a hospital or affiliated clinic operating under the hospital's license to also prescribe buprenorphine.
NUMBER OF NURSES AND PHYSICIAN ASSISTANT A PHYSICIAN MAY OVERSEE
Under present law, to be authorized to prescribe buprenorphine products, a nurse or physician assistant's supervising physician must not oversee more than two nurses or physician assistants at one time during clinical operations. This bill clarifies that this provision does not apply in a hospital or affiliated clinic operating under the hospital's license.
ON MARCH 28, 2024, THE SENATE ADOPTED AMENDMENT #1 AND PASSED SENATE BILL 2297, AS AMENDED.
AMENDMENT #1 rewrites the bill to, instead, add to present law on the use of buprenorphine products, as follows:
(1) Establishes that a licensed physician is the only healthcare provider authorized to prescribe a buprenorphine product for an FDA-approved use in recovery or medication-assisted treatment;
(2) Prohibits healthcare providers not licensed as physicians, and who are otherwise permitted to prescribe Schedule II or III drugs, from prescribing a buprenorphine product for the treatment of opioid use disorder unless the provider meets the following criteria:
(A) Is licensed and has practiced as a family, adult, or psychiatric nurse practitioner or physician assistant in this state;
(B) Has had no limitations or conditions imposed on the provider's license by the provider's licensing authority within the previous three years;
(C) Is employed by a hospital that operates with an agreement to train providers from a public or private medical school within this state, or an affiliated clinic operated under the hospital's license, that employs one or more physicians and has adopted clinical protocols for medication-assisted treatment;
(D) Is employed at a facility at which healthcare providers are contracted and credentialed with TennCare and TennCare's managed care organizations to treat opioid use disorder with buprenorphine products for use in recovery or medication-assisted treatment;
(E) Is employed at a facility at which healthcare providers are accepting new TennCare enrollees or patients for treatment of opiate addiction;
(F) Is employed by a facility that requires patients to verify identification;
(G) Does not write a prescription for a buprenorphine product that exceeds a 16-milligram daily equivalent;
(H) Does not prescribe or dispense a mono product or buprenorphine without naloxone;
(I) Works under the supervision of a physician who is actively treating patients with buprenorphine products for recovery or medication-assisted treatment;
(J) Prescribes buprenorphine products only to patients who are treated through the organization that employs the provider;
(K) Is supervised by or collaborates with a physician who is limited to the supervision of, or collaboration with, a maximum of four licensed nurse practitioners or physician assistants;
(L) Is supervised by or collaborates with a physician who reviews 100 percent of the charts of the patients being prescribed a buprenorphine product;
(M) Weighs the risk of relapse with the benefit of tapering down or off of buprenorphine when, similar to other disease states, tapering from the treatment medication is clinically appropriate and in agreement with the patient and tapering schedules and durations are patient specific;
(N) Initiates and leads a discussion regarding patient readiness to taper down or taper off treatment medications employed in the patient's treatment with each patient at any time upon the patient's request but no later than one year after initiating treatment and then every six months thereafter;
(O) Writes prescriptions that can only be dispensed by a licensed pharmacy; and
(P) Writes prescriptions of buprenorphine products to 50 or fewer patients at any given time; and
(3) Authorizes the health facilities commission to inspect facilities for compliance with the bill and requires the commission to report any violations to the appropriate licensing authority of the provider.

Statutes affected:
Introduced: 53-11-311, 53-11-311(h)(1)