Despite a slowdown in new waivers to prescribe buprenorphine during COVID-19, treatment capacity nonetheless grew at a stable rate, a new Health Affairs study has found.
This was due to already authorized clinicians obtaining waivers to prescribe for larger groups of patients. Advanced practice nurses (APNs) accounted for the largest portion of capacity growth during the pandemic, the study found.
The study relied on DEA Registrant Files from 2018 through 2022, which indicated clinician type and whether they have an X waiver to prescribe buprenorphine. It also included the number of patients authorized by the waiver, which the researchers used to track quarterly growth and potential treatment capacity.
Until mid-2021, though, there was a slowdown in new waivers among all clinicians; a significantly larger number of APNs obtained waivers afterward as opposed to physicians. In addition, physician assistants also obtained new waivers, together growing treatment capacity to a higher point than before the pandemic.
Opioid overdose deaths surged during the pandemic, and access to buprenorphine treatment continues to be key to combating the crisis. During the pandemic, there were numerous efforts to maintain access, including emergency authorization for the use of telehealth for buprenorphine prescribing, offering home delivery and suspending urine drug testing. The Drug Enforcement Administration also relaxed training requirements for clinicians to obtain waivers mid-2021.
The study referred to existing research that shows newly waivered rural APNs are more likely than rural physicians to prescribe buprenorphine, and waivered APNs are more likely than physicians to prescribe buprenorphine to Medicaid enrollees. APN waiver growth could slow, and buprenorphine prescribing could be affected by state restrictions requiring physician oversight, the study noted. Nevertheless, for now, APN and physician assistant treatment capacity has continued to rise despite these regulatory barriers.
“Policy and practice leaders need to support growth in the buprenorphine prescribing workforce and to facilitate clinicians prescribing to the maximum level allowed,” the study authors concluded.