Table. Mean Percentage of Clinicians per State With Waivers to Prescribe Buprenorphine in Office Settings as of September 2018a.
| Mean (95% CI) | ||
|---|---|---|
| Unadjusted | Adjustedb | |
| Nurse Practitioners | ||
| State does not require physician oversight of NPs, % (n = 27) | 5.58 (4.68 to 6.48) | 4.73 (4.72 to 4.74) |
| State requires physician oversight of NPs, % (n = 24) | 2.44 (1.78 to 3.10) | 2.70 (2.69 to 2.70) |
| Difference | 3.14 (2.05 to 4.23) | 2.03 (2.02 to 2.04) |
| P value | <.001c | <.001 |
| Physician Assistants | ||
| State has 5-6 essential elements of PA practice, % (n = 23)d | 1.74 (1.36 to 2.12) | 1.76 (1.44 to 2.08) |
| State has <5 essential elements of PA practice, % (n = 28) | 1.59 (1.16 to 2.02) | 1.58 (1.28 to 1.88) |
| Difference | 0.15 (−0.41 to 0.71) | 0.18 (−0.26 to 0.62) |
| P value | .60c | .42 |
Abbreviations: NP, nurse practitioner; PA, physician assistant.
Data are for 50 states and the District of Columbia. Data are weighted by the number of the type of clinician in the state (eg, number of NPs for the mean of NPs). Data on the number of Drug Addiction Treatment Act waivers held by all physicians, NPs, and PAs for each state as of September 26, 2018, were provided by the Substance Abuse and Mental Health Services Administration. These data included the count of all clinicians, regardless of whether they chose to be publicly listed. The percentage of each type of clinician per state was calculated by dividing the number of waivered clinicians by the total number of clinicians. Data on licensed physicians and NPs were from the Area Health Resource File and data on certified PAs were from the National Commission on Certification of Physician Assistants.
Adjusted means calculated from weighted least squares regressions. The dependent variables were the percentages of NPs and PAs with waivers. The independent variables of interest were binary indicators for whether NPs can prescribe without physician oversight (for NP regression) and whether the state has at least 5 of the essential elements of PA practice (for PA regression). The control variable was the percentage of physicians in the state with a waiver. The NP regression was weighted by the number of NPs in the state; the PA regression was weighted by the number of PAs in the state.
P values are from 2-group Hotelling T2 tests of whether the means are different for states with scope of practice restrictions vs less/no restriction.
The 6 “essential elements” are (1) licensure as the regulatory term (rather than certification); (2) authority to prescribe all legal medications; (3) scope of practice is determined at the practice level rather than by state regulation; (4) collaboration requirements can be adapted for the physician-PA relationship and practice setting; (5) co-signature requirements are determined at the practice level rather than by state regulation; and (6) the number of PAs a physician may collaborate with is determined at the practice level.6