Only 20% of people with an opioid use disorder get any treatment and of those 34% of people with opioid use disorder receive evidence-based treatment. Buprenorphine-naloxone can be prescribed as an outpatient medication which patients can take without traveling to a facility, but a prescription for this drug can only be written by federally waivered clinicians.

In 2017, The Comprehensive Addiction and Recovery Act allowed nurse practitioners and physician assistants the ability to obtain federal waivers that allow them to prescribe buprenorphine. This expanded access to treatment, especially for patients in rural areas.

In a study published in Health Affairs, assistant professor of health policy and management in the department of health policy and management at the Harvard T. H. Chan School of Public Health Michael L. Barnett, PhD, research assistant the department of health policy and management at the Harvard T. H. Chan School of Public Health Dennis Lee, and Margaret T. Morris Professor of Health Care Policy Richard G. Frank, PhD, report that from 2016 to 2019 the number of waivered clinicians in rural areas per 100,000 population increased by 111%.

Nurse practitioners and physician assistants accounted for more than half of this increase and were the first clinicians to receive waivers in 285 rural counties.

“The rapid growth in the numbers of nurse practitioners and physician assistants with buprenorphine waivers is a promising development in improving access to addiction treatment in rural areas.” The authors stated.

Physician assistants and nurse practitioners are more likely to treat vulnerable rural populations, which means lowering the barriers for their buprenorphine waivers could improve patient access in ways that expanded physician waivers may not be able to achieve.