The impact of CARA mandates on nurse practitioner controlled substance prescribing in Oregon: a cohort study

Substance Abuse Treatment, Prevention, and Policy

Tracy A. Klein¹  Sheila Markwardt²  Daniel Hartung³ 

[1] College of Nursing, Washington State University Vancouver, 14204 NE Salmon Creek Avenue, 98686-9600, Vancouver, WA, USA;OHSU Biostatistics and Design Program, Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, 97239-3098, Portland, OR, USA;OSU/OHSU College of Pharmacy, Oregon Health and Science University, Collaborative Life Sciences Building (CLSB), 2730 SW Moody Ave., CL5CP, 97201-5042, Portland, OR, USA;

关键词: Buprenorphine;    Nurse practitioner;    Substance use disorder;    Opioids;   

DOI  :  10.1186/s13011-022-00431-z

来源: Springer

【 摘 要 】

BackgroundIn 2017, the United States Comprehensive Addiction and Recovery Act (CARA) expanded authorization to prescribe buprenorphine for opioid use disorder (OUD) to nurse practitioners (NPs). Compared to physicians, NPs were required to complete 16 additional hours of training on controlled substance prescribing before a buprenorphine waiver application. As this differential additional education mandate was seen as a potential barrier, we evaluated the impact of this requirement on both NP waiver acquisition and prescribing of controlled substances, comparing NPs who obtained waivers to those who had not.MethodsThrough 2016–2018 Oregon Prescription Drug Monitoring Program and linked NP licensure data, we identified factors associated with waiver acquisition at baseline (2016) and evaluated changes in controlled substance prescribing before (2016) and after waiver acquisition (2018). Using chi-square and Mann-Whitney U testing, we calculated and described controlled substance prescribing types, rates, and patient level quantities including co-prescribing of benzodiazepines and opioids by NPs. Multivariable linear regression compared prescribing by waivered and non-waivered NPs for significant changes in non-buprenorphine controlled substance prescribing.ResultsWaivered NPs were more likely to have a psychiatric certification, have prior disciplinary action, and have generally higher levels of non-buprenorphine controlled substance prescribing than their non-waivered counterparts. While there was a significant increase in opioid prescriptions per patient among waivered NPs, following CARA implementation, co-prescribing of benzodiazepines and opioids significantly declined among waivered NPs relative to non-waivered NPs.ConclusionsAlthough educational requirements were rescinded in 2021 for most applicants, enhanced opioid prescribing training should be incorporated into professional educational offerings regardless of regulatory mandate. We recommended continued focus on education regarding avoidance of high risk prescribing such as co-prescribing of opioids and benzodiazepines. NPs who acquire waivers may take on higher risk patients already using opioids, and these findings may represent transitions in practice and patient setting.

【 授权许可】

CC BY