Oregon Senate Passes Bill to Let NPs supervise Psychologists in prescribing psych meds

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Why NP's? I'm not implying there bad because they're not, and yes they probably have more medical/ biological training than prescribing psychologist, but they have far less mental health/ psychiatric training.
Better lobby?

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I am pleasantly surprised that sanity prevailed and Gov Brown decided to stop this runaway train. If you feel inclined, you may want to contact her to thank her and reinforce the message that letting people with no medical training prescribe isn't the answer to a shortage of psychiatrists: State of Oregon: Governor Kate Brown - Share Your Opinion
 
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I am pleasantly surprised that sanity prevailed and Gov Brown decided to stop this runaway train. If you feel inclined, you may want to contact her to thank her and reinforce the message that letting people with no medical training prescribe isn't the answer to a shortage of psychiatrists: State of Oregon: Governor Kate Brown - Share Your Opinion
I think the message should be we need more access for psychotherapy for our patients not more people prescribing drugs for problems that cannot be medicated away! And really there needs to be better reimbursement of psychotherapy across the board so that it remains a valued activity
 
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This thread is pretty engaging.

I'm not in principle against having more people write meds... but being an addictionologist, with the opioid epidemic basically manufactured through reckless increased utilization, I can't help but think that increased availability without a lot of thought and care is going to trigger significant problems later on. It's prudent to be cautious when psychotropic meds have serious harm...

A lot of stimulant and benzo scripts are carelessly written by PMDs (let alone NPs/psychologists) who never fully demonstrated ADHD or GAD (and is chronic benzo even appropriate for GAD?) Now these meds are without a question safer than opioids, at least in the short term. But we don't fully understand their properties in the long term, and unscrupulously enlarging scope of care without considering these risks purely out of a profit motive is really problematic.

So then you say why not just allow people write non-controlled substances. The problem is people are not thorough, especially when the illness is poorly defined. So there are a lot of missed opportunities. I've also see NPs writing 10mg Lexapro scripts for 6 months and have the depression drag on. Not to say that MDs don't do this, but it's fairly clear that attempts to adherence to evidence based practice is much much much better. And I agree with the above, in a lot of cases the increased availability meds would necessarily have made any difference in accessibility, and in fact this is a form of "waste".
 
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This thread is pretty engaging.

I'm not in principle against having more people write meds... but being an addictionologist, with the opioid epidemic basically manufactured through reckless increased utilization, I can't help but think that increased availability without a lot of thought and care is going to trigger significant problems later on. It's prudent to be cautious when psychotropic meds have serious harm...

A lot of stimulant and benzo scripts are carelessly written by PMDs (let alone NPs/psychologists) who never fully demonstrated ADHD or GAD (and is chronic benzo even appropriate for GAD?) Now these meds are without a question safer than opioids, at least in the short term. But we don't fully understand their properties in the long term, and unscrupulously enlarging scope of care without considering these risks purely out of a profit motive is really problematic.

So then you say why not just allow people write non-controlled substances. The problem is people are not thorough, especially when the illness is poorly defined. So there are a lot of missed opportunities. I've also see NPs writing 10mg Lexapro scripts for 6 months and have the depression drag on. Not to say that MDs don't do this, but it's fairly clear that attempts to adherence to evidence based practice is much much much better. And I agree with the above, in a lot of cases the increased availability meds would necessarily have made any difference in accessibility, and in fact this is a form of "waste".

There are more Americans on psychiatric drugs per capita than any in any other developed nation in the world. Yet we are as psychologically/psychiatrially dysfunctional as ever (if not more so). Why do we you think we need more practitioners writing psychotropic Rxs?
 
Great points. I think we (the big we, including physicians, society and regulators) need to be looking more closely at what 'access to care' actually means and looks like. You could arbitrarily say that the system's goal or new standard of care for a pt with a mental health complaint is to see a 'medication prescriber' within x number of weeks. But the care delivered, outcomes, and risks are dramatically different depending on who that prescriber is - PCP, well-trained NP, online degree NP with no experience, psychiatrist, behavioral health integrated team, etc. To sloppily say the patient has 'access to care' because they saw a random MSW and an online degree-trained NP within 2-3 weeks of seeking care is nonsensical. Is it still access to care if the undertrained 'prescriber' throws an unsupported diagnosis on and prescribes a benzo or a stimulant? Is it access to care if they prescribe 50 mg of Zoloft with follow-up in 3 months? What about if they follow their algorithms, prescribe what seem to be appropriate meds on paper, and completely miss sleep apnea, hyperthyroidism, dementia, substance abuse, DV... and the patient suffers the consequences? I know it's tough to relay these concepts to regulators and the public, but we need to do more, either via APA, in our own communities, or elsewhere, because people are still not getting the difference between a full, well-practiced, evidence-based psychiatric evaluation, and a chat with an online-degree provider that will lead to one of four prescriptions nearly at random. It's dangerous to say that a patient has 'accessed care' when that care is not evidence-based, supported by sufficient training, or supervised closely by someone with such training and experience. This goes well beyond mental health to the explosions of undertrained NPs in numerous fields, and I hope it does not take a series of horrible outcomes to finally educate the public and regulating bodies.
 
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Next up: Certified registered nurse assistant practitioners, advanced medical assistant practitioners, and naturopathic psychiatrists with full prescription and psychotherapy privileges.
 
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Next up: Certified registered nurse assistant practitioners, advanced medical assistant practitioners, and naturopathic psychiatrists with full prescription and psychotherapy privileges.

That's DOCTOR Certified Registered Nurse Assistant Practitioner, thank you very much. My online program printout says DCRNAP, see? Also got a white coat and plastic stethoscope when I signed up, was a great Groupon. Next year I might go for my online Doctorate in Vet Tech (DVT) so I can do animal surgeries in my garage, I've always liked animals!
 
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Next up: Certified registered nurse assistant practitioners, advanced medical assistant practitioners, and naturopathic psychiatrists with full prescription and psychotherapy privileges.
You joke but in Washington naturopathic psychiatrists are a thing and have pretty much full prescribing privileges though can't rx schedule II drugs. They seem keen on giving pts chelation therapy though
 
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You joke but in Washington naturopathic psychiatrists are a thing and have pretty much full prescribing privileges though can't rx schedule II drugs. They seem keen on giving pts chelation therapy though
Wow... This... I don't even have words.
 
I think the message should be we need more access for psychotherapy for our patients not more people prescribing drugs for problems that cannot be medicated away! And really there needs to be better reimbursement of psychotherapy across the board so that it remains a valued activity

This for sure. Much less potential to do harm with psychotherapy in my opinion versus being able to write for benzos and stimulants freely. It's amazing what a little psychotherapy can do for people, even if you're not a pro and had extensive training in it. Empathic validation alone can be very powerful. A lot of problems indeed just cannot be medicated away. Social isolation for example. I remember in my residency training during our psychotherapy curriculum, we used to video tape some of our sessions then play it before our class and attendings for feedback. One of my sessions I happened to have gone 40 minutes without saying a word (early in my year, really wasn't sure what I was doing) and the patient just kept talking, pausing, reflecting and continued on. Towards the end of the session he was brought to tears and came up with some reasonable solutions to himself and developed insight. I really felt like I was too passive but apparently, by chance that session ended up going well. He was just happy to have someone listen.
 
I am pleasantly surprised that sanity prevailed and Gov Brown decided to stop this runaway train. If you feel inclined, you may want to contact her to thank her and reinforce the message that letting people with no medical training prescribe isn't the answer to a shortage of psychiatrists: State of Oregon: Governor Kate Brown - Share Your Opinion

Great idea, I think it would be great if most of the people who read this thread sent a message even if you're from another state to let them know people have been watching to see what happens.
 
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Nurse practitioners and psychologists shouldn't be allowed to write for stimulants or benzos (well, psychologists shouldnt even be allowed to write for anything). We have a big enough problem with benzo overRxing with physicians, adding para-professionals to the mix is not going to improve the situation.
 
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