Understanding the Prescribing Practices of Rural Nurse Practitioners and Physician Assistants with a DEA Waiver to Prescribe Buprenorphine

Research center:
Lead researcher:
Project funded:
September 2018
Project completed:
August 2019

The U.S. is in the midst of a severe and tragic opioid abuse epidemic. In 2015 more than 2 million Americans suffered from pain reliever disorder and more than half a million were using heroin. In 2016, an estimated 42,249 Americans died of an opioid drug overdose.

Data suggest that rural areas are disproportionately impacted. Both death rates and non-medical use of prescription drugs have been rising more rapidly in rural than urban areas. The most effective treatment options for opioid use disorder (OUD) include buprenorphine-naloxone, a medication differing from methadone in that office-based physicians, nurse practitioners (NPs) and physician assistants (PAs) with a Drug Enforcement Administration (DEA) waiver can prescribe it.

Several recent WWAMI RHRC studies have found a paucity of physicians located in rural areas who have a DEA waiver to prescribe buprenorphine as an office-based outpatient treatment for OUD and a relatively low percentage of physicians with a waiver who are prescribing, as well as described the barriers physicians report in providing this service. More than half of rural U.S. counties (and 44% of all counties) lack even a single waivered provider. Additionally, the presence of a provider who has obtained a DEA waiver in a county does not necessarily mean that buprenorphine treatment is available there. In a recent national survey of rural physicians with a DEA waiver, more than half (53%) of physicians with the initial 30-patient waiver reported they were not treating any patients.

No study has looked at the prescribing patterns of NPs and PAs in rural America who obtained a DEA waiver as allowed under the Comprehensive Addiction and Recovery Act. Other treatment options such as Opioid Treatment Centers are available in urban areas but are not readily available in rural locations. This study extended our past work, describing the availability of office-based outpatient treatment for OUD in rural areas by surveying all rural NPs and PAs with a DEA waiver to prescribe buprenorphine. The survey sought to quantify the number of rural NPs and PAs currently providing treatment, the number of patients being treated, and factors that facilitate or discourage these providers from offering treatment.