Increasing the Workforce that Provides Medication-Assisted Treatment for Opioid Use Disorder

Medication treatment for opioid use disorder is an important component of efforts to reduce the high social costs of prescription and non-prescription opioid abuse and mortality. This approach incorporates pharmacotherapies (e.g., buprenorphine, methadone, naltrexone) as part of treatment for opioid dependence. Buprenorphine’s effectiveness has been established in numerous studies and can be prescribed in office-based settings; thus, buprenorphine is particularly important to the expansion of access to medication treatment for opioid use disorder. However, the need for treatment dramatically outstrips the number of providers authorized to prescribe it, with particularly severe shortages of providers in rural areas. Many U.S. counties do not have a single provider.

In response to the shortage of buprenorphine prescribers, two federal workforce policies were established in 2016: (1) allowing nurse practitioners and physician assistants to become authorized to prescribe buprenorphine in office-based settings, and (2) increasing the maximum number of patients that can be prescribed buprenorphine by a physician from 100 to 275. Legislation passed in 2018 allows other advanced practice nurses (nurse-midwives, clinical nurse specialists, and nurse-anesthetists) to prescribe buprenorphine as well. These policies were expected to increase access to medication treatment for opioid use disorder for thousands of individuals. However, the degree to which these policies achieve their goal will depend on other environmental and policy factors, most importantly state laws that regulate advanced practice clinicians’ medication prescribing.

This research assesses the impacts of these workforce policies on the supply and geographic reach of opioid treatment providers, with a focus on whether and how state policies facilitate or impede growth in available prescribers. The first study, supported by the National Council of State Boards of Nursing, analyzed data on the availability of providers authorized to prescribe buprenorphine and involved site visits to four states to learn how state regulations facilitate and impede the ability of nurse practitioners to provide opioid treatment. The second study, supported by the National Institute on Drug Abuse, will use data from multiple sources from 2016 through 2022 to examine the growth of buprenorphine prescribers and utilization while controlling for other regulations and programs that might affect policy implementation. Findings from this research could be used to promote the harmonization of state and federal efforts to address the opioid crisis across the U.S. and in highly-impacted regions.