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.

Keywords

medication-assisted treatment buprenorphine CARA 2016 rural health opioid use disorder opioid treatment

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References

American Association of Nurse Practitioners. (2017). State practice environment. Retrieved from https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment

American Medical Association. (2015). Physician Masterfile [Data file]. Retrieved from https://www.ama-assn.org/life-career/ama-physician-masterfile

Andrilla

C. H. A.

(2016). Who treats opioid use disorder in rural America survey? Unpublished manuscript.

Andrilla

C. H. A.

Coulthard

Larson

E. H.

(2017). Barriers rural physicians face prescribing buprenorphine for opioid use disorder. Annals of Family Medicine, 15, 359-362.

Andrilla

C. H. A.

Coulthard

Patterson

D. G.

(2018). Prescribing practices of rural physicians waivered to prescribe buprenorphine. American Journal of Preventive Medicine, 54, S208-S214.

Andrilla

C. H. A.

Moore

T. E.

Patterson

D. G.

Larson

E. H.

(2019). Geographic distribution of providers with a DEA waiver to prescribe buprenorphine for the treatment of opioid use disorder: A 5-year update. Journal of Rural Health, 35, 108-112. doi:10.1111/jrh.12307

Andrilla

C. H. A.

Patterson

D. G.

Garberson

L. A.

Coulthard

Larson

E. H.

(2018). Geographic variation in the supply of selected behavioral health providers. American Journal of Preventive Medicine, 54, S199-S207.

Arfken

C. L.

Johanson

C. E.

di Menza

Schuster

C. R.

(2010). Expanding treatment capacity for opioid dependence with office-based treatment with buprenorphine: National surveys of physicians. Journal of Substance Abuse Treatment, 39, 96-104. doi:10.1016/j.jsat.2010.05.004

Buerhaus

P. I.

DesRoches

C. M.

Dittus

Donelan

(2015). Practice characteristics of primary care nurse practitioners and physicians. Nursing Outlook, 63, 144-153. doi:10.1016/j.outlook.2014.08.008

10.

Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51). Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.pdf

11.

Doescher

M. P.

Andrilla

C. H.

Skillman

S. M.

Morgan

Kaplan

(2014). The contribution of physicians, physician assistants, and nurse practitioners toward rural primary care: Findings from a 13-state survey. Medical Care, 52, 549-556. doi:10.1097/MLR.0000000000000135

12.

Drug Enforcement Administration. (2016). Drug Enforcement Administration (DEA) Monthly File [Data file]. Retrieved from https://dea.ntis.gov/monthly/

13.

Drug Enforcement Administration. (2017). Drug Enforcement Administration (DEA) Monthly File [Data file]. Retrieved from https://dea.ntis.gov/monthly/

14.

Hancock

Mennenga

King

Andrilla

Larson

Shou

(2017). Treating the rural opioid epidemic. Retrieved from https://www.ruralhealthweb.org/NRHA/media/Emerge_NRHA/Advocacy/Policy%20documents/Treating-the-Rural-Opioid-Epidemic_Feb-2017_NRHA-Policy-Paper.pdf

15.

Hedegaard

Warner

Minino

A. M.

(2017). Drug overdose deaths in the United States, 1999–2016 (NCHS Data Brief No. 273). Retrieved from https://www.cdc.gov/nchs/data/databriefs/db294.pdf

16.

Huhn

A. S.

Dunn

K. E.

(2017). Why aren’t physicians prescribing more buprenorphine? Journal of Substance Abuse Treatment, 78, 1-7. doi:10.1016/j.jsat.2017.04.005

17.

Kentucky Academy of Physician Assistants. (2018). PA Prescriptive Authority of Schedule Medications. Retrieved from http://kentuckypa.org/pa-prescriptive-authority-of-schedule-medications

18.

Kunins

H. V.

Sohler

N. L.

Giovanniello

Thompson

Cunningham

C. O.

(2013). A buprenorphine education and training program for primary care residents: Implementation and evaluation. Substance Abuse, 34, 242-247.

19.

Morgan

Everett

C. M.

Hing

(2014). Time spent with patients by physicians, nurse practitioners, and physician assistants in community health centers, 2006–2010. Healthcare, 2, 232-237. doi:10.1016/j.hjdsi.2014.09.009

20.

National Plan and Provider Enumeration System. (2017). National Provider Identifier (NPI) [Data file]. Retrieved from https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/NationalProvIdentStand/

21.

Polydorou

Gunderson

E. W.

Levin

F. R.

(2008). Training physicians to treat substance use disorders. Current Psychiatry Reports, 10, 399-404.

22.

Roose

R. J.

Kunins

H. V.

Sohler

N. L.

Elam

R. T.

Cunningham

C. O.

(2008). Nurse practitioner and physician assistant interest in prescribing buprenorphine. Journal of Substance Abuse Treatment, 34, 456-459. doi:10.1016/j.jsat.2007.05.009

23.

Rosenblatt

R. A.

Andrilla

C. H. A.

Catlin

Larson

E. H.

(2015). Geographic and specialty distribution of US physicians trained to treat opioid use disorder. Annals of Family Medicine, 13, 23-26. doi:10.1370/afm.1735

24.

Sigmon

S. C.

(2015). The untapped potential of office-based buprenorphine treatment. JAMA Psychiatry, 72, 395-396.

25.

Stein

B. D.

Pacula

R. L.

Gordon

A. J.

Burns

R. M.

Leslie

D. L.

Sorbero

M. J.

. . . Dick

A. W.

(2015). Where is buprenorphine dispensed to treat opioid use disorders? The role of private offices, opioid treatment programs, and substance abuse treatment facilities in urban and rural counties. Milbank Quarterly, 93, 561-583.

26.

Substance Abuse and Mental Health Services Administration. (2016). Drug Addiction Treatment Act of 2000. Retrieved from https://www.samhsa.gov/programs-campaigns/medication-assisted-treatment/legislation-regulations-guidelines#DATA-2000

27.

Substance Abuse and Mental Health Services Administration. (2018). Qualify for Nurse Practitioners (NPs) and Physician Assistant (PAs) waiver. Retrieved from https://www.samhsa.gov/programs-campaigns/medication-assisted-treatment/training-materials-resources/qualify-np-pa-waivers

28.

Suzuki

Connery

H. S.

Ellison

T. V.

Renner

J. A.

(2014). Preliminary survey of office-based opioid treatment practices and attitudes among psychiatrists never receiving buprenorphine training to those who received training during residency. American Journal on Addictions, 23, 618-622.

29.

Tenn. Code Ann. § 53-11-311. (2017). Retrieved from https://www.tn.gov/content/dam/tn/mentalhealth/documents/TCA%2053-11-311.pdf

30.

The Henry J. Kaiser Family Foundation. (2017a). Distribution of physicians by gender. Menlo Park, CA: Author.

31.

The Henry J. Kaiser Family Foundation. (2017b). Total number of nurse practitioners, by gender. Retrieved from https://www.kff.org/other/state-indicator/total-number-of-nurse-practitioners-by-gender/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

32.

The Henry J. Kaiser Family Foundation. (2017c). Total number of physician assistants, by gender. Retrieved from https://www.kff.org/other/state-indicator/total-physician-assistants/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

33.

Thomas

C. P.

Fullerton

C. A.

Kim

Montejano

Lyman

D. R.

Dougherty

R. H.

. . . Delphin-Rittmon

M. E.

(2014). Medication-assisted treatment with buprenorphine: Assessing the evidence. Psychiatric Services, 65, 158-170. doi:10.1176/appi.ps.201300256

34.

U.S. Department of Agriculture. (2013). Urban Influence Codes [Data file]. Retrieved from https://www.ers.usda.gov/data-products/urban-influence-codes.aspx

35.

U.S. Department of Health & Human Services. (2016). Area Health Resources File [Data file]. Retrieved from https://datawarehouse.hrsa.gov/data/datadownload.aspx#MainContent_ctl00_gvDD_lbl_dd_topic_ttl_0