The Association Between Scope of Practice Regulations and Nurse Practitioner Prescribing of Buprenorphine After the 2016 Opioid Bill

Abstract

This article examines the relationship between federal regulations, state scope-of-practice regulations on nurse practitioners (NPs), and buprenorphine prescribing patterns using pharmacy claims data from Optum's deidentified Clinformatics Data Mart between January 2015 and September 2018. The county-level proportion of patients filling prescriptions written by NPs was low even after the 2016 Comprehensive Addiction and Recovery Act (CARA), 2.7% in states that did not require physician oversight of NPs, and 1.1% in states that did. While analyses in rural counties showed higher rates of buprenorphine prescriptions written by NPs, rates were still considerably low: 3.7% in states with less restrictive regulations and 1.1% in other states. These results indicate that less restrictive scope-of-practice regulations are associated with greater NP prescribing following CARA. The small magnitude of the changes indicates that federal attempts to expand treatment access through CARA have been limited.

Keywords: Comprehensive Addiction and Recovery Act; buprenorphine prescribing; nurse practitioners; scope-of-practice regulations.

Figure 1:. Buprenorphine Prescribing by NPs in Less Restrictive States Vs. More Restrictive States, 2015Q1 – 2018Q3

Source/Notes: Authors’ calculations of county-level proportion of patients who filled buprenorphine prescriptions written by NPs based pharmacy claims data from the 100% controlled substance universe of Optum’s de-identified Clinformatics® Data Mart Database 2015Q1 to 2018Q3. 2016Q3 is the implementation quarter of CARA 2016. The orange and blue lines show the mean proportion of patients who filled buprenorphine prescriptions written by NPs per quarter. The red dashed line is the aggregate number of individuals (national level) who filled any buprenorphine prescriptions per quarter. Error bars present the 95% CIs.

Figure 2:. Antibiotic and NSAID Prescribing by NPs in Less Restrictive States Vs. More Restrictive States, 2015Q1 – 2018Q3

Source/Notes: Authors’ calculations of county-level proportion of patients who filled NSAID or antibiotic prescriptions written by NPs based pharmacy claims data from the 100% controlled substance universe of Optum’s de-identified Clinformatics® Data Mart Database 2015Q1 to 2018Q3. The red and navy lines show the mean proportion of patients who filled prescriptions written by NPs per quarter. The gray dashed line is the aggregate number of individuals (national level) who filled any relevant prescription per quarter. Error bars present the 95% CIs.