Accessing the Oregon Frontier: The Impact of Expanding Authority for Buprenorphine to Nurse Practitioners

Abstract

Access to providers of treatment for opioid use disorder is a critical challenge to confronting the opioid epidemic. In 2017, the Comprehensive Addiction and Recovery Act (CARA) expanded buprenorphine prescribing privileges to nurse practitioners (NP). This research examined the effect of this regulatory change on buprenorphine prescribing in the state of Oregon.We performed an interrupted time‐series (ITS) analysis to examine the effect of CARA implementation (February 2017) on buprenorphine prescribing for medications to treat opioid disorders (MOUD) from January 1, 2016 to December 31, 2018. Specifically, we characterized changes in the trend and patterns of buprenorphine prescribing overall, by prescriber type (NPs vs MD/DO), and geographic designation. Our ITS regression models estimated prepolicy trends, immediate changes after CARA implementation, and changes in trend following implementation.We used Oregon Prescription Drug Monitoring Program data linked to a provider and dispensing characteristic files. Our study sample post‐CARA included 179 NPs with a total of 440 525 buprenorphine prescriptions statewide written by all prescribers.Prior to CARA implementation, the trend in total buprenorphine dispensing was increasing by 149 prescriptions per month (P < .001). Following implementation, the trend in buprenorphine dispensing increased significantly by 75 prescriptions per month (P = .015). This increase was entirely driven by new NP prescribing of buprenorphine as the trend in MD/DO prescribing was unchanged (P = .65). By December 2018, 15% of buprenorphine prescriptions were prescribed by NPs. The proportion of buprenorphine prescribed by NPs increased in both urban (0.4% per month; P < .001) and rural areas (0.6% per month; P < .001). The increase was particularly large in counties classified as frontier (six or fewer people per square mile) where the proportion of buprenorphine prescribed by NPs increased from 1.2% to 23%.Buprenorphine dispensing rates in Oregon increased significantly following CARA implementation. The impact of adding NPs as authorized prescribers has enhanced access to buprenorphine prescriptions in rural and sparsely populated areas of the state where such patients were previously underserved.Expanding buprenorphine prescribing authority to NPs is a promising approach to improve access to MOUD, particularly in frontier counties where certified treatment centers do not exist. However, only 179 of the state’s 4946 licensed NPs prescribed buprenorphine demonstrating the need to for efforts to facilitate certification for these providers.WSU College of Nursing.