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Opioids & SU
The Literature Collection contains over 10,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
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Substance use disorder (SUD), more specifically opioid use disorder, is a national epidemic. Although there is an emphasis on treatment and increasing treatment locations, there continues to be a gap between the number of people with SUD and the number of treatment centers. To help narrow this gap, some primary care clinicians started providing medication-assisted treatment (MAT) on an outpatient basis in their offices. This option enables clinicians to provide treatment in their own communities, which increases access to treatment and decreases costs. It also enables the clinician and the person with SUD/opioid use disorder to build a relationship, which many clinicians believe is the foundation of successful treatment. The clinician, whether a doctor, a physician assistant, or an advanced practice nurse, has to obtain a Drug Addiction Treatment Act 2000 waiver to provide MAT beyond naltrexone, which has a required educational program and includes a limitation on the number of clients. Conversely, a possible drawback to this type of treatment is the potential for the disruption of continuity of care with regard to psychotherapy treatment. Federal law mandates that therapy is available and provided to people receiving MAT. The clinician may not be able to provide this service and would need to refer the person with SUD for psychotherapy treatment. It may be clinically significant for a type of follow-up communication to be implemented so that the clinician and the therapy provider can maximize SUD treatment success.
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.