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. 2020 Aug:115:108032.
doi: 10.1016/j.jsat.2020.108032. Epub 2020 May 13.

Buprenorphine waiver uptake among nurse practitioners and physician assistants: The role of existing waivered prescriber supply

Samantha G Auty  1 , Michael D Stein  2 , Alexander Y Walley  3 , Mari-Lynn Drainoni  4
Affiliations

Buprenorphine waiver uptake among nurse practitioners and physician assistants: The role of existing waivered prescriber supply

Samantha G Auty et al. J Subst Abuse Treat. 2020 Aug.

Abstract

Background: Buprenorphine is an effective pharmacotherapy for the treatment of opioid use disorder (OUD), but recent increases in the rate of OUD in the U.S. have outpaced the supply of clinicians waivered to prescribe buprenorphine. To increase the supply of buprenorphine prescribers, the Comprehensive Addiction and Recovery Act expanded buprenorphine prescribing waiver eligibility beyond physicians to nurse practitioners (NP) and physician assistants (PA) in 2017. Little is known about patterns of waiver uptake among NPs and PAs. This study examined associations between the existing supply of waivered prescribers and waiver uptake among NPs and PAs in U.S. states.

Methods: NP and PA waiver uptake was evaluated as the number of NPs or PAs obtaining an initial buprenorphine prescribing waiver per 10,000 state residents from January 2017 to December 2018 using data from the Buprenorphine Waiver Notification System. NP and PA waiver uptake was estimated as a function of existing waivered prescriber supply, OUD treatment capacity, and other state characteristics using generalized least squares (GLS) regression.

Results: 28,010 NPs and PAs have become waivered to prescribe buprenorphine since January 2017. GLS regressions indicated that waivered prescriber supply was significantly, positively associated with both NP (b = 0.101 p < 0.001) and PA (b = 0.030, p < 0.001) waiver uptake. Results suggest an addition of ten waivered prescribers to existing supply was associated with an increase of one waivered NP, and an addition of thirty-three waivered prescribers to existing supply was associated with an increase of one waivered PA.

Conclusions: NP and PA waiver uptake is strongly associated with the existing supply of waivered prescribers in a state, suggesting NPs and PAs may be more likely to acquire waivers in states with a high existing supply of buprenorphine prescribers. Additional policy solutions are needed to scale up the supply of buprenorphine prescribers in underserved states.

Keywords: Buprenorphine; Nurse practitioners; Opioid use disorder; Physician assistants; Treatment capacity.

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Conflict of interest statement

Declaration of competing interest The authors have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Waivered prescriber supply per 10,000 residents pre- to post-waiver expansion.
See this image and copyright information in PMC

References

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    1. Substance Abuse and Mental Health Services Administration. (2018a). Buprenorphine Waiver Notification System. https://www.samhsa.gov/medication-assistedtreatment/practitioner-program...

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