Many people who need treatment for substance use disorders are not receiving it. Though there are many physicians with waivers to provide buprenorphine for medication-assisted treatment, they tend to be clustered in and around urban centers,1 leaving many rural counties without access to treatment.

In fact, 60.1 percent of rural counties in the United States lack a physician with a DATA 2000 waiver to prescribe buprenorphine.2 To widen the availability of medication-assisted treatment using buprenorphine, the 2016 Comprehensive Addiction and Recovery Act authorized SAMHSA to allow nurse practitioners (NPs) and physician assistants (PAs) to apply for waivers to prescribe buprenorphine to treat opioid addiction.

To receive the DATA 2000 waiver, NPs and PAs must complete 24 hours of training (triple the 8 hours required of physicians). To make training more accessible to NPs and PAs, including those in remote areas, SAMHSA offers the training free through the Providers' Clinical Support System for Medication-Assisted Treatment.
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SAMHSA started certifying NPs and PAs on Feb. 21, 2017, and as of Aug. 29 there were 2,471 certified NPs and 687 certified PAs.

However, one roadblock to fully utilizing NPs and PAs as a force for treatment is the law in certain states. More than half of U.S. states specifically restrict or prevent NPs and PAs from prescribing buprenorphine under their scope of practice laws. In 28 states,3 an NP must work in collaboration with a physician who is licensed to prescribe buprenorphine—a restriction that allows for increases in availability of buprenorphine but does nothing to increase its geographic accessibility.

As of July 2017, only one state (Tennessee) and two U.S. territories (the Commonwealth of the Northern Mariana Islands and Puerto Rico) prohibit NPs and PAs from prescribing buprenorphine under any conditions. For more information on the controlled substances authority for NPs and PAs by discipline within the state of which they practice, please visit https://www.deadiversion.usdoj.gov/drugreg/practioners.

More buprenorphine prescribers are needed to combat the opioid crisis and treat substance use disorders, particularly in rural areas. This could happen with state legislation that extends a prescribing capacity to NPs and PAs, or by incentivizing current prescribers to take on more patients. Regardless, buprenorphine should be part of a comprehensive treatment plan that includes counseling and recovery support.
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This is the first issue of SAMHSA's Buprenorphine Prescriber News. Each issue will have a brief article or two about the opioid crisis, addressing topics such as opioid prescription practices, opioid use, opioid overdoses, opioid overdose deaths, buprenorphine treatment, and policy and program issues and actions, as well as announcements about upcoming events and links to helpful resources. We hope you find it useful.

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SAMHSA's Opioid Overdose Prevention Toolkit provides information to help those at risk avoid overdose and to educate families, communities, and health workers about the potential for overdose, as well as the dangers of opioid misuse and abuse.

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1 Rosenblatt, R., Andrilla, C.H., Catlin, M., & Larson, E. (2015). Geographic and specialty distribution of U.S. physicians trained to treat opioid use disorder. Annals of Family Medicine, 13(1), 23–26. http://doi.org/10.1370/afm.1735

2 Andrilla, H. A., Coulthard, C., & Larson, E.H. (2017). Barriers rural physicians face prescribing buprenorphine for opioid use disorder. Annals of Family Medicine 15(4), 359–362.

3 Vestal, C. (2017). Nurse licensing laws block treatment for opioid addiction. The Pew Charitable Trusts. Retrieved from http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/04/21/nurse-licensing-laws-block-treatment-for-opioid-addiction
The views, opinions, and content of this publication do not necessarily reflect the views, opinions, or policies of SAMHSA or the U.S. Department of Health and Human Services.