Joanne Spetz, PhDProfessorPhilip R. Lee Institute for Health Policy StudiesSan Francisco, CA 94143-0936

Waivers to Allow PAs and NPs to Prescribe Buprenorphine Vary by State Interview with:

Joanne Spetz, PhDProfessorPhilip R. Lee Institute for Health Policy StudiesSan Francisco, CA 94143-0936

Dr. Spetz

Joanne Spetz, PhD
Philip R. Lee Institute for Health Policy Studies
San Francisco, CA 94143-0936 What is the background for this study? What are the main findings? 

Response: Medication treatment is an important component of treatment for opioid use disorder. Buprenorphine has been the focus of policies designed to increase access to treatment and is the most widely-used medication due to well-established evidence of its efficacy and its accessibility outside licensed narcotics treatment programs. The most common brand name for this medication is Suboxone.

There is a shortage of providers authorized to prescribe it, in part because only physicians were permitted to obtain waivers from the Drug Enforcement Agency to prescribe it outside of licensed narcotics treatment programs until the opioid bill of 2016. That bill granted nurse practitioners (NPs) and physician assistants (PAs) the ability to apply for waivers. However, in states that require NPs and/or PAs to be supervised by or collaborate with a physician, there are additional requirements regarding the training of the physician before the NP or PA can apply for a waiver. This affects nearly half of states for NPs, and all states for PAs.

We found that the average percentage of NPs with waivers was 5.6% in states that do not require physician supervision, but only 2.4% in more restrictive states. Even after adjusting for other factors, we found that the percentage of NPs with waivers was 75% higher when physician oversight is not required. We didn’t find a similar result for PAs, probably because they must have physician oversight in all states. What should readers take away from your report? 

Response: States that require that NPs collaborate with or be supervised by a physician may see less growth in their opioid treatment workforce, which is a problem in many states that have been hit hard by the opioid crisis.

These states should consider modernizing their scope of practice regulations to overcome the barriers that now exist. If supervision or collaboration regulations cannot be changed, state policymakers should develop programs to help connect NPs and PAs with physicians willing to supervise them in offering buprenorphine. They also should make sure that NPs and PAs, and the other advanced practice nurses now allowed to get waivers, are aware of this opportunity and know how to complete the education requirement to do so. What recommendations do you have for future research as a result of this work?

Response: We are continuing our research by visiting four states with different scope of practice regulations for NPs and different rates of growth in the opioid treatment workforce, to learn how states are supporting access to treatment both with and without physician oversight requirements. We will be visiting West Virginia in April, and are in the early stages of planning visits to Ohio, Michigan, and New Mexico. We also are continuing our data analysis to learn whether regulations are having different impacts in urban versus rural areas. Is there anything else you would like to add?

Response: Our study is supported by the National Council of State Boards of Nursing. They provided feedback on our proposal but do not have any control over our study results or publications.


Spetz J, Toretsky C, Chapman S, Phoenix B, Tierney M. Nurse Practitioner and Physician Assistant Waivers to Prescribe Buprenorphine and State Scope of Practice Restrictions. JAMA. 2019;321(14):1407–1408. doi:10.1001/jama.2019.0834

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Last Updated on April 9, 2019 by Marie Benz MD FAAD