“When We… Are Allowed to Do Good Things, We Do Great Things”: An Exploration of Nurse and Midwife Prescribing in Substance Use Treatment

Background: The global opioid crisis continues to escalate, driving high mortality and straining health systems. Although medications for opioid use disorder are highly effective, access remains limited due to a shortage of prescribers. Nurses and midwives—often more accessible than physicians—could help bridge this gap. International evidence shows their prescribing to be safe and effective, yet legislative, educational, and professional barriers persist. This study explored perspectives of nurses and midwives from multiple countries on their experiences, barriers, and enablers related to prescribing in addiction care. Methods: A qualitative descriptive design was used. Four online focus groups were conducted in 2024 with 17 nurses and midwives from Europe, Ireland, the United States, and Australasia, recruited through professional networks and snowball sampling. A semi-structured guide explored experiences, barriers, and policy implications. Sessions (60–90 minutes) were recorded, transcribed, and thematically analyzed using Braun and Clarke’s six-phase framework. Two researchers independently coded transcripts, with themes validated by the research team. Results: Four themes emerged: (1) Integrating prescribing for innovation—prescribing enabled holistic, patient-centered care, and improved access, especially in underserved areas. (2) Transformative potential—prescriptive authority facilitated timely medications for opioid use disorder access, enhanced autonomy, and strengthened therapeutic relationships. (3) Systemic and professional challenges—legislative limits, inconsistent training, inadequate institutional support, and physician resistance impeded progress. (4) Reconfiguring collaboration—prescribing shifted interprofessional dynamics, reduced dependence on physicians, and challenged stigma in addiction nursing. Conclusions: Nurse and midwife prescribing enhances access, supports holistic treatment, and empowers practitioners. Addressing legislative, educational, and professional barriers through policy reform, standardized training, mentorship, and antistigma strategies is crucial to realizing its full impact.