I’m an introvert, and speaking to legislators on Capitol Hill was never on my bingo card. That changed this year when I attended my first Addiction Medicine Advocacy Conference (AMAC) with American Society of Addiction Medicine. This two-day event brings clinicians together to meet with legislators and discuss addiction treatment and prevention.

I arrived to DC a couple days early to take in some sights. One of our tours stopped at the Vietnam War Memorial. If you’ve ever been there, you know it is striking to see the names of all of those who perished carved onto the wall, more than 58,000 Americans killed over the course of several years during that war. That moment triggered a thought: today, we lose nearly twice as many Americans every year to overdose. For the past several years, it’s been nearly 110,000 deaths per year. Putting that into perspective really makes you pause and wonder why it doesn’t get more attention.

One of the bills on our agenda was the Modernization of Opioid Treatment Access Act (MOTAA). Methadone, a full agonist medication, is highly restricted in the U.S. and dispensed only through Opioid Treatment Programs (OTPs), which are federally regulated clinics. These clinics exist in fewer than 80% of U.S. counties, making access a significant challenge.

Maine and New Hampshire represent states comprised of largely rural areas with limited access to addiction treatment. Nearly half of the 26 counties across Maine and New Hampshire are without OTPs. In these states, advocacy for access should be at the forefront. MOTAA would deregulate methadone, allowing addiction specialists to prescribe it in outpatient settings without requiring the daily visits often mandated at OTPs. That said, many patients will still benefit from OTPs, which will continue to exist. The goal is not to replace one model with another, but to expand access, provide an additional level of care, and return decision-making to clinicians rather than the system.

The bill would only allow addiction specialist physicians to prescribe it. These clinicians are also quite limited in the U.S., so while this is a potential solution, it may not be the best solution. In the UK, methadone dispensing is not as tightly regulated, and is prescribed much like buprenorphine is in the U.S. Not surprisingly, with greater access, comes greater participation in treatment — more than 50% of people in the UK with opioid use disorder (OUD) are engaged in treatment and nearly all of them are on a medication for OUD. In stark contrast, treatment engagement is less than 30% in the U.S. for those with OUD. It also makes sense that the overdose rate would be significantly lower in the UK, since patients receiving medications for OUD have greater protection against overdose. Several senators and representatives have already co-signed the bill in support of MOTAA, including Senator Hassan from New Hampshire who I had the pleasure of meeting. She remains very invested in making strides for addiction treatment and access.

I came away with a few lessons from the visit. Firstly, our expertise and experience matter. Sharing our stories helps legislators better understand the bills before them. Second, networking matters. When it comes to making meaningful change, sometimes it’s who, not how. I learned this from the book of the same title written by Dan Sullivan, recommended by an amazing professor at Vanderbilt, Dr. Barut. Your one voice may seem small but with persistence and numbers and a strong combination of “whos,” we can influence change. Don’t discredit your power in words or connections.

But what also stood out to me was how few NPs were in the room. Out of nearly 100 attendees at the AMAC, I was one of only two NPs — and the sole representative from New Hampshire. It left me asking: Where were the other advanced practice nurses? Psych NPs, addiction NPs, adult NPs, acute-care NPs — there are so many of us committed to this field and eager to support legislation that drives change.

That absence matters. NPs are often on the front lines of addiction care, managing medication, supporting recovery, and navigating barriers with patients every day. We see firsthand how policy impacts practice and how lives are affected by access, or lack thereof. If we aren’t present in these rooms, our perspectives and our patients’ experiences risk being underrepresented.

Of course I recognize that the barriers are real. Most of us are balancing full-time jobs, caring for families, and managing countless responsibilities. Taking time away to advocate isn’t easy, especially knowing that change rarely happens overnight. And yet, persistence matters. We saw this with the removal of the DATA-Waiver requirement to prescribe buprenorphine (a major success after steady years of advocacy that was highlighted at this year’s conference). I’ll be honest, I should have gotten involved years ago, but ultimately it took the encouragement of strong female leaders to spark my interest and build my confidence. My boss, Dr. Grawert, and Vanderbilt University School of Nursing's Professor Dr. Ziegler are two of the people that encouraged my involvement in advocacy.

I think that’s what more NPs need: mentorship, encouragement, and an invitation to the table. This is how we draw future generations into continuing the work that has already begun.

Lastly, something I heard during these meetings that I had to ponder: It was stated that legislators don’t want to sponsor too many bills because their sponsorship becomes less important in the eyes of others. I understood the statement and sentiment, but I also found it disappointing. Considering the snail speed we see with changes in government, I think a different position should be considered. Instead of worrying about the politics of appearances, why wouldn’t they support every initiative that makes sense? In this day and age of instant gratification, rapid technological change, and evolving evidence, younger generations need to see Congress embracing progress, not clinging to outdated ideals. I hope we can move out of the dark ages and beyond outdated, decades-old legislation and ideals that hold us back, and work toward progressive changes on more realistic timelines. People’s lives depend on it.

Carrie Grassi is a health care executive, nurse practitioner, and DNP candidate at Vanderbilt University with over two decades of experience transforming care for individuals with substance use disorders. She currently serves as vice president of Medical Services at Aware Recovery Care, where she leads innovative programs in virtual detox, MAT access, and integrated behavioral health.

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