FINAL VERSION FOR E-BLAST (11/2/15)
YOUR NAME
YOUR HOME ADDRESS
CITY, STATE, ZIP
DATE
If writing to a U.S. Senator
The Honorable (First Name Last Name)
United States Senate
Washington, DC 20510
If writing to a U.S. Representative
The Honorable (First Name Last Name)
United States House of Representatives
Washington, DC 20515
RE: The Recovery Enhancement for Addiction Treatment Act or TREAT Act (S. 1455 / H.R. 2536).
Dear Senator __________ (Last Name) >>>OR<<<< Representative __________(Last Name):
1ST paragraph: <<<<<Introduce yourself and your qualifications (ex. that you are an addictions nurse and
a member of the International Nurses Society on Addictions—IntNSA). If you are a Certified Addictions
Registered Nurse (CARN) or Certified Addictions Registered Nurse-Advanced Practice (CARN-AP),
mention that here too. If you reside in that legislator’s state or district, point that out. (BUT, be sure
that you are representing yourself as a private citizen and an addictions nurse, and are not
representing IntNSA as an organization).
I want to sincerely thank you for supporting >>>> OR<<<< I am writing to urge you to support the
Recovery Enhancement for Addiction Treatment Act or TREAT Act (S. 1455 and its companion bill, H.R.
2536). This legislation is of vital importance to increase access to evidence based, life-saving
pharmacotherapy for individuals addicted to opioids such as heroin and prescription pain medications.
I appreciate that the TREAT Act amends the Controlled Substances Act to expand the definition of
“qualifying practitioners” to include not only physicians, but also advanced practice nurses (nurse
practitioners) and physician assistants with prescriptive authority within their respective states. This has
the potential to greatly expand treatment capacity for individuals with opioid addiction by allowing
nurse practitioners to prescribe for, treat and monitor individuals in recovery from opioid dependence
using FDA approved medications such as buprenorphine products (for example, Suboxone or Subutex).
However, I strongly object to specific wording regarding certain aspects of the TREAT Act (S. 1455 and
its companion bill, H.R. 2536) as currently written.
First, Section (II) (cc) requires nurse practitioners or physician assistants to “practice under the
supervision of licensed physicians who hold an active waiver…for opioid addiction therapy”, and section
(III) (cc) requires that nurse practitioners prescribe opioid therapy “in collaboration with a physician
who holds an active waiver…” As currently worded, the above language would place additional
restrictions on nurse practitioners who practice in designated “Full Practice” states. These nurse
practitioners already practice without direct physician supervision or collaborative agreements.
Instead, I recommend that these sections be amended to include language about nurse practitioners
practicing in accordance with the Nurse Practice Acts in their respective states.
Letter to Senator OR Congressman ________________ (NAME)
DATE (MM/DD/YYYY)
PAGE 2
As of July 2015, twenty-one (21) states plus the District of Columbia (43% of states) are designated as
“Full Practice” states. In these states, state practice and licensure laws provide for nurse practitioners
evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatments—
including prescribe medications—under the exclusive licensure authority of the State Board of Nursing.
This is the model recommended by the Institute of Medicine (IOM) and the National Council of State
Boards of Nursing (http://www.aanp.org/legislation-regulation/state-legislation/state-practiceenvironment).
Seventeen states (33% of states) are currently designated as “Reduced Practice” states, in which state
practice and licensure laws require a “regulated collaborative agreement” with an outside health
discipline (usually medicine) in order for the nurse practitioner to provide patient care. Only twelve
states (24% of states) are “Restricted Practice” states that require “supervision, delegation or team
management” by an outside health discipline in order for the nurse practitioner to provide care.
Further, there are very few physicians who have active waivers for treating opioid addiction with
narcotic medications (such as buprenorphine or Suboxone), and even fewer waivered physicians that
are actually willing to prescribe medication assisted therapy. This would make it very difficult for nurse
practitioners to enter into such supervisory or collaborative agreements. As currently worded, this
would create another unintended consequence that would greatly limit the ability of the TREAT Act to
sufficiently remedy existing access barriers and expand treatment capacity, and ultimately, would
limit the ability of individuals with opioid addiction to receive life-saving pharmacotherapy.
Additionally, I request that the words “for pain” be stricken from Section (II) (aa) and Section (III) (aa),
which refer to the nurse practitioner being “licensed under State law to prescribe schedule III, IV, or V
medications for pain”. Typically, schedule III, IV or V medications may be prescribed for a variety of
health conditions, including pain, and the scope of practice for nurse practitioners with privileges to
prescribe schedule III, IV or V medications is not limited to prescribing medications only for pain. Again,
this problem can be resolved by merely including language about nurse practitioners practicing in
accordance with the Nurse Practice Acts in their respective states.
I commend the authors of the TREAT Act for amending the Drug Addiction Treatment Act of 2000, to
raise the cap for the number of patients practitioners can treat from 30 to 100, and with special
permission, an unlimited number of patients, given the establishment of need.
I also greatly approve of the amendments in the TREAT Act which require practitioners to demonstrate
specialization to treat opiate dependent patients. For nurse practitioners, such competencies can be
demonstrated by certification in addictions nursing as a Certified Addictions Registered NurseAdvanced Practice (CARN-AP).
Letter to Senator OR Congressman ________________ (NAME)
DATE (MM/DD/YYYY)
PAGE 3
In conclusion, I hope that you will vote to pass The Recovery Enhancement for Addiction Treatment
Act – TREAT Act (S. 1455 IF WRITING TO A SENATOR) >>>OR<<< (H.R. 2536 IF WRITING TO A MEMBER
OF CONGRESS), with the suggested revisions outlined above.
Thank you for your consideration of these remarks. Please contact me if I can be of any assistance to
you, or if you have any questions about addictions or addictions nursing, now or in the future. If I cannot
personally help you, I will direct you to someone who can.
Sincerely yours,
TYPE YOUR FULL NAME HERE
YOUR EMAIL ADDRESS HERE
YOUR PHONE NUMBER HERE
CC: INCLUDE THE NAME OF ANY PERSON THAT YOU WANT TO CC HERE (ex. Congressional staff persons)