Christopher L Rowe1, Jennifer Ahern2, Alan Hubbard3, Phillip O Coffin4. 1. Division of Epidemiology, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Floor 5, Berkeley, CA 94704, USA; Center on Substance Use and Health, San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA 94102, USA. Electronic address: chrisrowe@berkeley.edu. 2. Division of Epidemiology, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Floor 5, Berkeley, CA 94704, USA. 3. Division of Biostatistics, School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Floor 5, Berkeley, CA 94704, USA. 4. Center on Substance Use and Health, San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA 94102, USA; Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, 533 Parnassus Ave, San Francisco, CA 94143, USA.
Abstract
AIMS: To evaluate associations between new types of buprenorphine waivers (nurse practitioner and physician assistant [NP/PA]; 275-patient limit [MD/DO-275]) and both buprenorphine prescribing and health outcomes. METHODS: Using comprehensive county-level data from California 2010-2018, we modeled quarterly associations between numbers of NP/PA and MD/DO-275 waivers and rates of buprenorphine prescribing, opioid-related deaths, emergency department (ED) visits, and hospitalizations among all counties and separately among metropolitan and nonmetropolitan counties using Poisson regression models with county and quarter fixed effects and adjusting for time-varying covariates. RESULTS: Each additional NP/PA and MD/DO-275 waiver was associated with a 2.6% (95%CI: 1.1-4.1%) and 5.8% (4.1-7.4%) increase in buprenorphine prescribing among nonmetropolitan counties, respectively. Each additional MD/DO-275 waiver was associated with a 2.8% (1.0%-4.6%) increase in buprenorphine among metropolitan counties. There were no statistically significant associations between NP/PA waivers and buprenorphine prescribing among metropolitan counties or among either waiver type and opioid-related health outcomes. CONCLUSIONS: NP/PA waivers were associated with increased buprenorphine prescribing among nonmetropolitan counties and MD/DO-275 waivers were associated with increased buprenorphine prescribing among both metropolitan and nonmetropolitan counties.
AIMS: To evaluate associations between new types of buprenorphine waivers (nurse practitioner and physician assistant [NP/PA]; 275-patient limit [MD/DO-275]) and both buprenorphine prescribing and health outcomes. METHODS: Using comprehensive county-level data from California 2010-2018, we modeled quarterly associations between numbers of NP/PA and MD/DO-275 waivers and rates of buprenorphine prescribing, opioid-related deaths, emergency department (ED) visits, and hospitalizations among all counties and separately among metropolitan and nonmetropolitan counties using Poisson regression models with county and quarter fixed effects and adjusting for time-varying covariates. RESULTS: Each additional NP/PA and MD/DO-275 waiver was associated with a 2.6% (95%CI: 1.1-4.1%) and 5.8% (4.1-7.4%) increase in buprenorphine prescribing among nonmetropolitan counties, respectively. Each additional MD/DO-275 waiver was associated with a 2.8% (1.0%-4.6%) increase in buprenorphine among metropolitan counties. There were no statistically significant associations between NP/PA waivers and buprenorphine prescribing among metropolitan counties or among either waiver type and opioid-related health outcomes. CONCLUSIONS: NP/PA waivers were associated with increased buprenorphine prescribing among nonmetropolitan counties and MD/DO-275 waivers were associated with increased buprenorphine prescribing among both metropolitan and nonmetropolitan counties.