Auty Samantha G, Stein Michael D, Walley Alexander Y, Drainoni Mari-Lynn
Department of Health Law, Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, 1 Medical Center Place, Boston, MA, 02118, USA.
J Subst Abuse Treat. 2020 Aug;115:108032. doi: 10.1016/j.jsat.2020.108032. Epub 2020 May 13.
Buprenorphine is an effective pharmacotherapy for the treatment of opioid use disorder (OUD), but recent increases in the rate of OUD in the U.S. have outpaced the supply of clinicians waivered to prescribe buprenorphine. To increase the supply of buprenorphine prescribers, the Comprehensive Addiction and Recovery Act expanded buprenorphine prescribing waiver eligibility beyond physicians to nurse practitioners (NP) and physician assistants (PA) in 2017. Little is known about patterns of waiver uptake among NPs and PAs. This study examined associations between the existing supply of waivered prescribers and waiver uptake among NPs and PAs in U.S. states.
NP and PA waiver uptake was evaluated as the number of NPs or PAs obtaining an initial buprenorphine prescribing waiver per 10,000 state residents from January 2017 to December 2018 using data from the Buprenorphine Waiver Notification System. NP and PA waiver uptake was estimated as a function of existing waivered prescriber supply, OUD treatment capacity, and other state characteristics using generalized least squares (GLS) regression.
28,010 NPs and PAs have become waivered to prescribe buprenorphine since January 2017. GLS regressions indicated that waivered prescriber supply was significantly, positively associated with both NP (b = 0.101 p < 0.001) and PA (b = 0.030, p < 0.001) waiver uptake. Results suggest an addition of ten waivered prescribers to existing supply was associated with an increase of one waivered NP, and an addition of thirty-three waivered prescribers to existing supply was associated with an increase of one waivered PA.
NP and PA waiver uptake is strongly associated with the existing supply of waivered prescribers in a state, suggesting NPs and PAs may be more likely to acquire waivers in states with a high existing supply of buprenorphine prescribers. Additional policy solutions are needed to scale up the supply of buprenorphine prescribers in underserved states.
丁丙诺啡是治疗阿片类物质使用障碍（OUD）的一种有效药物疗法，但美国近期OUD发病率的增长超过了获得开具丁丙诺啡豁免权的临床医生数量。为增加丁丙诺啡处方医生的数量，《综合成瘾与康复法案》于2017年将丁丙诺啡处方豁免资格从医生扩大到执业护士（NP）和医师助理（PA）。关于NP和PA中豁免权获取模式的了解甚少。本研究调查了美国各州已获得豁免权的处方医生现有数量与NP和PA中豁免权获取之间的关联。
使用来自丁丙诺啡豁免通知系统的数据，将2017年1月至2018年12月期间每10000名州居民中获得初始丁丙诺啡处方豁免权的NP或PA数量作为NP和PA豁免权获取情况的评估指标。使用广义最小二乘法（GLS）回归，将NP和PA豁免权获取情况估计为现有获得豁免权的处方医生数量、OUD治疗能力及其他州特征的函数。
自2017年1月以来，已有28010名NP和PA获得开具丁丙诺啡的豁免权。GLS回归表明，获得豁免权的处方医生数量与NP（b = 0.101，p < 0.001）和PA（b = 0.030，p < 0.001）的豁免权获取均呈显著正相关。结果表明，在现有数量基础上每增加10名获得豁免权的处方医生，会使获得豁免权的NP增加1名；在现有数量基础上每增加33名获得豁免权的处方医生，会使获得豁免权的PA增加1名。
NP和PA的豁免权获取与一个州中现有获得豁免权的处方医生数量密切相关，这表明在丁丙诺啡处方医生现有数量较多的州，NP和PA获得豁免权的可能性可能更高。需要采取更多政策措施来扩大在服务不足州的丁丙诺啡处方医生数量。
