Barbara Andraka-Christou1, Adam J Gordon2, Joanne Spetz3, Rachel Totaram4, Matthew Golan5, Olivia Randall-Kosich6, Jordan Harrison7, Spencer Calder2, Stefan G Kertesz8, Bradley D Stein7. 1. School of Health Management & Informatics, University of Central Florida, Orlando, FL, United States of America; Department of Internal Medicine, University of Central Florida, Orlando, FL, United States of America. Electronic address: barbara.andraka@ucf.edu. 2. Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, United States of America; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America; Vulnerable Veteran Innovative PACT (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, UT, United States of America. 3. Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States of America. 4. School of Health Management & Informatics, University of Central Florida, Orlando, FL, United States of America. 5. School of Law, Emory University, Atlanta, GA, United States of America. 6. School of Public Health, Georgia State University, Atlanta, GA, United States of America. 7. RAND Corporation, Pittsburgh, PA, United States of America. 8. Birmingham, Alabama VA Health Care System, Birmingham, AL, United States of America; Division of Preventive Medicine, University of Alabama, Birmingham, AL, United States of America.
Abstract
BACKGROUND: Buprenorphine is a life-saving medication for people with opioid use disorder (OUD). U.S. federal law allows advanced practice clinicians (APCs), such as nurse practitioners (NPs) and physician assistants (PAs), to obtain a federal waiver to prescribe buprenorphine in office-based practices. However, states regulate APCs' scope of practice (SOP) variously, including requirements for physician supervision. States may also have laws entirely banning NP/PA buprenorphine prescribing or requiring that supervising physicians have a federal waiver to prescribe buprenorphine. We sought to identify prevalence of state laws other than SOP laws that either 1) prohibit NP/PA buprenorphine prescribing entirely, or 2) require supervision by a federally waivered physician. METHODS: We searched for state statutes and regulations in all 50 states and Washington D.C. regulating prescribing of buprenorphine for OUD by APCs during summer 2021. We excluded general scope of practice laws, laws only applicable to Medicaid-funded clinicians, laws not applicable to substance use disorder (SUD) treatment, and laws only applicable to NPs/PAs serving licensed SUD treatment facilities. We then conducted content analysis. RESULTS: One state prohibits all APCs from prescribing buprenorphine for OUD, even though the state's general SOP laws permit APC buprenorphine prescribing. Five states require PA supervision by a federally waivered physician. Three states require NP supervision by a federally waivered physician. CONCLUSIONS: Aside from general scope of practice laws, several states have created laws explicitly regulating buprenorphine prescribing by APCs outside of licensed state SUD facilities.
BACKGROUND: Buprenorphine is a life-saving medication for people with opioid use disorder (OUD). U.S. federal law allows advanced practice clinicians (APCs), such as nurse practitioners (NPs) and physician assistants (PAs), to obtain a federal waiver to prescribe buprenorphine in office-based practices. However, states regulate APCs' scope of practice (SOP) variously, including requirements for physician supervision. States may also have laws entirely banning NP/PA buprenorphine prescribing or requiring that supervising physicians have a federal waiver to prescribe buprenorphine. We sought to identify prevalence of state laws other than SOP laws that either 1) prohibit NP/PA buprenorphine prescribing entirely, or 2) require supervision by a federally waivered physician. METHODS: We searched for state statutes and regulations in all 50 states and Washington D.C. regulating prescribing of buprenorphine for OUD by APCs during summer 2021. We excluded general scope of practice laws, laws only applicable to Medicaid-funded clinicians, laws not applicable to substance use disorder (SUD) treatment, and laws only applicable to NPs/PAs serving licensed SUD treatment facilities. We then conducted content analysis. RESULTS: One state prohibits all APCs from prescribing buprenorphine for OUD, even though the state's general SOP laws permit APC buprenorphine prescribing. Five states require PA supervision by a federally waivered physician. Three states require NP supervision by a federally waivered physician. CONCLUSIONS: Aside from general scope of practice laws, several states have created laws explicitly regulating buprenorphine prescribing by APCs outside of licensed state SUD facilities.
Keywords:
Advanced care practitioners; Buprenorphine; Collaboration; Medications for opioid use disorder; Nurse practitioners; Opioid use disorder; Physician assistants; Scope of practice; State law; Supervision; Waiver
Authors: Sarah E Wakeman; Marc R Larochelle; Omid Ameli; Christine E Chaisson; Jeffrey Thomas McPheeters; William H Crown; Francisca Azocar; Darshak M Sanghavi Journal: JAMA Netw Open Date: 2020-02-05