Projected Contributions of Nurse Practitioners and Physicians Assistant to Buprenorphine Treatment Services for Opioid Use Disorder in Rural Areas

Abstract

The United States is experiencing an opioid use disorder epidemic. The Comprehensive Addiction and Recovery Act allows nurse practitioners (NPs) and physician assistants (PAs) to obtain a Drug Enforcement Administration waiver to prescribe medication-assisted treatment (MAT) for opioid use disorder. This study projected the potential increase in MAT availability provided by NPs and PAs for rural patients. Using workforce and survey data, and state scope of practice regulations, the number of treatment slots that could be provided by NPs and PAs was estimated for rural areas. NPs and PAs are projected to increase the number of rural patients treated with buprenorphine by 10,777 (15.2%). Census Divisions varied substantially in the number of projected new treatment slots per 10,000 population (0.8-10.6). The New England and East South Central Census Divisions are projected to have the largest population-adjusted increase. NPs and PAs have considerable potential to reduce substantial MAT access disparities.

Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA

“…A recent study found that more restrictive scope of practice laws were associated with fewer NPs with buprenorphine waivers; however, no significant effect was found for PAs and scope of practice laws [161]. Less restrictive NP and PA scope of practice laws are particularly important in rural areas where NPs and PAs serve a critical role in healthcare service delivery [162].…”

States Should Remove Barriers to Advanced Practice Registered Nurse Prescriptive Authority to Increase Access to Treatment for Opioid Use Disorder

“…DATA 2000 permitted "qualified physicians" who hoped to prescribe buprenorphine within their offices to obtain a DEA waiver to do so. Initially, DATA 2000 allowed physicians to treat up to 30 patients and after 1 year, apply for a waiver to increase the number of patients they could treat to 100 (Andrilla, Patterson, Moore, et al, 2018). It explicitly prohibited physicians from delegating buprenorphine prescribing to nonphysicians including NPs even if they had a DEA number and lived in a state without barriers to prescriptive authority.…”

Psychiatric Mental Health Nurse Practitioners Meeting Rural Mental Health Challenges

“…Given the state of rural mental health affairs, PMHNPs and physician colleagues are equipped to organize and advocate politically for PMHNP full scope of practice (i.e., independent practice) and challenge constraining mandated physician supervision (Andrilla, Patterson, Moore, Coulthard, & Larson, 2018; Chapman, Toretksy, & Phoenix, 2019; de Nesnera & Allen, 2016; Delaney et al, 2018; Spetz, Skillman, & Andrilla, 2017). Mandated supervision is financially costly, falsely justifies unequal reimbursement for comparable work, supports inequitable professional relations, increases administrative burden, and overall decreases mental health access to services from all involved providers (Chapman et al, 2019; de Nesnera & Allen, 2016).…”

“…States with full-practice rights for PMHNPs demonstrate increased service provision to vulnerable and rural populations and associated cost savings, improved self-reported mental health among patients, and decreased mental health–related mortality (Alexander & Schnell, 2019; Martsolf, Auerbach, & Arifkhanova, 2015; Phoenix, Hurd, & Chapman, 2016; Xue, Ye, Brewer, & Spetz, 2016). Of note, PMHNPs with independent practice rights working in community mental health clinics provided twice as many mental health visits and treated more patients compared with colleagues in states who did not have independent practice rights and can combat the opioid crisis after obtaining a prescribing waiver (e.g., buprenorphine) once they have completed a 24-hour training (Andrilla et al, 2018; Substance Abuse and Mental Health Services Administration, 2017; Tierney, Finnell, Naegle, LaBelle, & Gordon, 2015; Yang et al, 2017). Overall, the PMHNP workforce is growing—it is essential that state policies reflect practice autonomy, Drug Enforcement Administration prescribing rights, acute care admitting privileges, expanded clinical roles, and independent billing to support PMHNP presence, satisfaction, and position longevity in rural areas (Chapman, Phoenix, Hahn, & Strod, 2018; Delaney, Drew, & Rushton, 2019; Owens, 2019; Spetz et al, 2017).…”