Perceptions of buprenorphine barriers and efficacy among nurse practitioners and physician assistants

Barbara Andraka-Christou, Cory Page, Victoria Schoebel, Jessica Buche, Rebecca L. Haffajee

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background: Medications for opioid use disorder (MOUDs), including methadone, buprenorphine, and naltrexone, decrease mortality and morbidity for people with opioid use disorder (OUD). Buprenorphine and methadone have the strongest evidence base among MOUDs. Unlike methadone, buprenorphine may be prescribed in office-based settings in the U.S., including by nurse practitioners (NPs) and physician assistants (PAs) who have a federal waiver and adhere to federal patient limits. Buprenorphine is underutilized nationally, particularly in rural areas, and NPs/PAs could help address this gap. Therefore, we sought to identify perceptions of buprenorphine efficacy and perceptions of prescribing barriers among NPs/PAs. We also sought to compare perceived buprenorphine efficacy and perceived prescribing barriers between waivered and non-waivered NPs/PAs, as well as to compare perceived buprenorphine efficacy to perceived naltrexone and methadone efficacy. Methods: We disseminated an online survey to a random national sample of NPs/PAs. We used Mann–Whitney U tests to compare between waivered and non-waivered respondents. We used non-parametric Friedman tests and post-hoc Wilcoxon signed-rank tests to compare perceptions of medication types. Results: 240 respondents participated (6.5% response rate). Most respondents agreed buprenorphine is efficacious and believed counseling and peer support should complement buprenorphine. Buprenorphine was generally perceived as more efficacious than both naltrexone and methadone. Perceived buprenorphine efficacy and prescribing barriers differed by waiver status. Non-waivered practitioners were more likely than waivered practitioners to have concerns about buprenorphine affecting patient mix. Among waivered NPs/PAs, key buprenorphine prescribing barriers were insurance prior authorization and detoxification access. Conclusions: Our results suggest that different policies should target perceived barriers affecting waivered versus non-waivered NPs/PAs. Concerns about patient mix suggest stigmatization of patients with OUD. NP/PA education is needed about comparative medication efficaciousness, particularly regarding methadone. Even though many buprenorphine treatment patients benefits from counseling and/or peer support groups, NPs/PAs should be informed that such psychosocial treatment methods are not necessary for all buprenorphine patients.

Original languageEnglish (US)
Article number43
JournalAddiction Science and Clinical Practice
Volume17
Issue number1
DOIs
StatePublished - Dec 2022
Externally publishedYes

Bibliographical note

Funding Information:
This manuscript was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling approximately $900,000. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement by, HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. We would also like to acknowledge Angela Beck, PhD, MPH, for her support of our project.

Funding Information:
We would also like to acknowledge Angela Beck, PhD, MPH, for her support of our project. Some of the data in this study was included in a report for the University of Michigan Behavioral Health Workforce Research Center in October 2018. The report does not include comparison of waivered versus non-waivered practitioners’ perceptions. That report is called: Nurse Practitioner and Physician Assistant Provision of Medication-Assisted Treatment for Opioid Use Disorder: A Survey of Knowledge, Engagement, and Perceptions. It is available at www.Y3-FA3-P2-NP-PA-MAT-Full-Report.pdf (www.behavioralhealthworkforce.org).

Publisher Copyright:
© 2022, The Author(s).

Keywords

  • Barriers
  • Buprenorphine
  • Counseling
  • Detoxification
  • Efficacy
  • Methadone
  • Naltrexone
  • Nurse practitioners
  • Peer support
  • Perceptions
  • Physician assistants
  • Prior authorization
  • Survey

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