Ko Hyunkyu, Fritz Julie M, Higgins Thomas F, Brodke Darrel S, Martin Brook I
Department of Orthopaedics, School of Medicine, University of Utah, Salt Lake City, UT.
Department of Physical Therapy, College of Health, University of Utah, Salt Lake City, UT.
Spine (Phila Pa 1976). 2025 Sep 15;50(18):E375-E382. doi: 10.1097/BRS.0000000000005243. Epub 2025 May 1.
Observational cohort study.
To examine the effects of the Comprehensive Addiction and Recovery Act (CARA) on buprenorphine prescribing and opioid use disorder (OUD) among Medicare beneficiaries with back pain.
Enacted in January 2017, CARA extended buprenorphine prescribing authority to Nurse Practitioners (NP) and Physician Assistants (PA) to treat OUD, defined as a physical or psychological dependence on opioids, but adoption varied by state. Leveraging this policy variation, we examined the effect of CARA on buprenorphine prescribing and OUD employing Medicare beneficiaries over age 65 with back pain from 2016 to 2019, and who were eligible for Part D prescription drug benefits. Only buprenorphine and buprenorphine/naloxone combinations that are FDA-approved for OUD treatment were included as our outcome.
A difference-in-difference regression examined the change in buprenorphine prescribing and OUD before and after CARA between states that did and did not expand prescription authority. Subgroup analysis examined treatment effect heterogeneity by sex and race/ethnicity.
States that adopted a full scope-of-practice under CARA had a significant increase in buprenorphine prescribing (6.5%, 95% CI: 1.3%, 12.2%) and a reduction in OUD (7.2%, 95% CI: -9.3%, -4.8%) compared with states that did not expand prescribing authority after the policy implementation. States that expanded prescribing authority following CARA had a disproportionate increase in use of buprenorphine and a reduction in OUD among males and Hispanic patients compared with female and White patients. The magnitude of the policy effects increased over time across all groups.
CARA was associated with increased buprenorphine prescribing and a reduction in OUD among older adults with back pain. Expanded authorization of prescription of buprenorphine to treat OUD by NPs/PAs in states that have not adopted full scope-of-practice under CARA might effectively reduce OUD, as well as racial/ethnic disparities in buprenorphine prescribing and OUD.
Level 3.
观察性队列研究。
探讨《综合成瘾与康复法案》（CARA）对患有背痛的医疗保险受益人中丁丙诺啡处方开具及阿片类物质使用障碍（OUD）的影响。
CARA于2017年1月颁布，将丁丙诺啡处方开具权扩展至执业护士（NP）和医师助理（PA）以治疗OUD，OUD被定义为对阿片类物质的身体或心理依赖，但各州的采用情况有所不同。利用这一政策差异，我们研究了CARA对2016年至2019年患有背痛且符合D部分处方药福利资格的65岁以上医疗保险受益人的丁丙诺啡处方开具及OUD的影响。仅将美国食品药品监督管理局（FDA）批准用于OUD治疗的丁丙诺啡及丁丙诺啡/纳洛酮组合作为我们的研究结果。
采用双重差分回归分析在扩大和未扩大处方权的州之间，CARA前后丁丙诺啡处方开具及OUD的变化。亚组分析按性别和种族/民族检验治疗效果的异质性。
与政策实施后未扩大处方权的州相比，在CARA下采用全面执业范围的州丁丙诺啡处方开具显著增加（6.5%，95%置信区间：1.3%，12.2%）且OUD减少（7.2%，95%置信区间：-9.3%，-4.8%）。与女性和白人患者相比，在CARA后扩大处方权的州中，男性和西班牙裔患者丁丙诺啡的使用增加比例过高且OUD减少。随着时间推移，所有组的政策效果幅度均有所增加。
CARA与患有背痛的老年人丁丙诺啡处方开具增加及OUD减少相关。在未根据CARA采用全面执业范围的州，扩大NP/PA开具丁丙诺啡治疗OUD的授权可能有效减少OUD，以及丁丙诺啡处方开具和OUD方面的种族/民族差异。
3级。
