The ARC-PA requires physician assistant
programs to provide some instruction in the
“detection and treatment of substance abuse”
although the nature and extent of this instruction
is not specified.^80 The PANCE exam may
include addiction in its psychiatry/behavioral
exam category.* 81
As of 2010, all states permit physicians to
delegate prescription privileges to physician
assistants^82 and all states except Florida and
Kentucky allow physician assistants to prescribe
certain controlled substances under medical
supervision.^83 Yet physician assistants, like
other medical professionals, receive little
training in addiction in spite of the fact that they
can prescribe controlled substances.†
Nurses. States offer several categories of
licensing in the nursing profession, each with
different standards, practice limitations and
supervision requirements. As they do for
physicians, states defer to national accreditation
agencies and professional boards for specific
licensing standards for nurses. To be a licensed
registered nurse (RN), one must graduate from
an accredited nursing program which includes
earning either a bachelor’s of science degree in
nursing (BSN), an associate’s degree in nursing
(ADN) or completing a diploma program
(administered in hospitals).^84 Graduates from
each program are eligible to take the National
Council Licensure Exam (NCLEX),
administered by the National Council of State
- Each question addresses one organ system along
with one of seven practice areas: history taking and
physical examinations, using laboratory and
diagnostic studies, formulating a most likely
diagnosis, health maintenance, clinical interventions,
pharmaceutical therapeutics and applying basic
science concepts.
† A few states require physician assistants to be
trained in addiction. Physician assistants in CA who
wish to prescribe controlled substances without
advanced approval from a supervising physician are
required to take a controlled substance education
course which includes assessment of risky substance
use and addiction. In OK, all physician assistants
must complete one hour of continuing education per
year on the topic of addiction.
Boards of Nursing, and they must pass this exam
to become a licensed RN.^85Even though most nurses interact regularly with
individuals who are risky users or who have
addiction,^86 CASA Columbia’s review found
that in all but several states‡ addiction-related
education is not required explicitly in curriculum
guidelines for state nursing programs. Other
research found that many nursing education
programs do not teach current information
related to addiction.^87 The National League for
Nursing Accrediting Commission and the
Commission on Collegiate Nursing Education,
the two main accrediting agencies for nursing
schools, do not require addiction to be part of
nursing curricula.^88 Addiction, including the
topic of smoking cessation, may be included as
topics on the licensing exams for registered and
practical/vocational nurses.^89 The American
Academy of Nursing recently published new
core clinical competencies in mental health that
should be expected of all RNs. They include
knowledge about the disease of addiction,
addiction treatment, the pharmacology of
commonly-misused illicit and prescription
drugs, comprehensive screening, motivational
interviewing, patient outcome evaluation,
comprehension of research literature and the
adoption of evidence-based practices.^90In most states, advanced practice nurses (APN)
must earn a master’s degree and are authorized
to prescribe both non-controlled and controlled
substances;^91 however, few states explicitly
include addiction-related content in their training
requirements.The International Nurses Society on Addictions
(IntNSA) offers an optional certificate in
addiction nursing; to qualify, candidates must‡ In CA, RNs must complete studies in alcohol and
other drug addiction; however, the exact amount is
not specified. In IL, programs in practical nursing
must include a course in pharmacology which must
include topics on substance use and addiction. IN
and RI require some addiction education and NJ
requires six contact hours in pharmacology related to
controlled substances including the prevention and
management of addiction involving these substances.