Closing the Opioid Use Disorder Treatment Gap: Expanding Nurse Practitioners' Prescriptive Authority

• In Event: Supply-Side Healthcare Policies: Effects on Entry, Access, and Quality

Abstract

The opioid crisis remains a critical public health challenge in the U.S., with significant gaps in treatment access for Opioid Use Disorder (OUD). This study evaluates the impact of the Comprehensive Addiction and Recovery Act (CARA) of 2016, which allowed Nurse Practitioners (NPs) to prescribe buprenorphine. Leveraging pre-existing state-level regulations on NPs' prescription authority and comparing pre- and post-CARA implementation periods, I examine the effect of allowing NPs to prescribe buprenorphine independently. Results indicate it substantially increased NP participation in prescribing buprenorphine, growing the provider base by 27%. This expansion significantly increased buprenorphine dispensation by 16%, leading to an 11% reduction in opioid-related mortality. This is the first paper to demonstrate that increased access to buprenorphine directly reduces opioid-related mortality.

However, expanding NPs' prescribing authority also introduced unintended negative effects. Data reveals a rise in opioid misuse, including increased dispensation of oxycodone and hydrocodone, two substances central to the early opioid epidemic. Survey evidence further supports increased illicit drug use post-policy. These unintended outcomes highlight a moral hazard: as buprenorphine availability increased, patients may have misused or co-consumed opioids, believing they faced lower overdose risks.

Provider competition further influenced these outcomes. In counties previously lacking treatment providers, the introduction of NP prescribers led to a significant reduction in opioid-related mortality. Conversely, in highly competitive regions already served by multiple providers, new prescribers issued longer prescriptions, averaging nearly five additional days per prescription. This deviation from standard practice may compromise long-term patient recovery, potentially undermining broader public health benefits. Policymakers should weigh these trade-offs when considering further deregulation of buprenorphine prescribing authority.

Author

• Lance Gui, University of Arizona
  Presenting Author