Beyond state scope of practice laws for advanced practitioners: Additional supervision requirements for buprenorphine prescribing.

TitleBeyond state scope of practice laws for advanced practitioners: Additional supervision requirements for buprenorphine prescribing.
Publication TypeJournal Article
Year of Publication2022
AuthorsAndraka-Christou, B, Gordon, AJ, Spetz, J, Totaram, R, Golan, M, Randall-Kosich, O, Harrison, J, Calder, S, Kertesz, SG, Stein, BD
JournalJ Subst Abuse Treat
Volume138
Pagination108715
Date Published2022 Jul
ISSN1873-6483
KeywordsBuprenorphine, Humans, Opiate Substitution Treatment, Opioid-Related Disorders, Physician Assistants, Practice Patterns, Physicians', Scope of Practice, United States
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.

DOI10.1016/j.jsat.2021.108715
Alternate JournalJ Subst Abuse Treat
PubMed ID35067400
PubMed Central IDPMC9167216
Grant ListR01 DA047379 / DA / NIDA NIH HHS / United States
UG1 DA049444 / DA / NIDA NIH HHS / United States
I50 HX003009 / HX / HSRD VA / United States
R01 DA045800 / DA / NIDA NIH HHS / United States
P50 DA046351 / DA / NIDA NIH HHS / United States