landscape in Malheur County, Oregon
Malheur County is one of 10 Oregon counties considered a frontier area because it has six or less people per square mile. Nurse practitioners have quickly gained a key role in making opioid addiction treatment available in such counties.

Giving nurse practitioners the authority to prescribe buprenorphine has brought that gold standard treatment for opioid addiction to people who might not have had access to it before, according to a new study led by Tracy Klein, PhD, associate professor at the Washington State University College of Nursing in Vancouver.

Klein and her colleagues Dan Hartung, PharmD, and Jonah Geddes, MPH, used Prescription Drug Monitoring Data to look at prescription and dispensing patterns in Oregon before and after nurse practitioners and physician assistants gained the authority to prescribe buprenorphine in 2017. Before that time, only physicians were allowed to prescribe the medication nationally.

Tracy Klein
Dr. Tracy Klein

Her study found that nurse practitioners almost immediately had an impact on access to buprenorphine in rural Oregon, especially in the sparsely populated areas known as frontier regions – counties with six or fewer people per square mile.

By the end of 2018, nurse practitioners accounted for nearly 1 in 5 buprenorphine prescriptions in rural Oregon, according to the study, published in the Journal of Rural Health. In frontier areas – 10 of Oregon’s 36 counties – nurse practitioners accounted for more than a third of buprenorphine prescriptions dispensed, it said.

Nurse practitioners are sometimes the only healthcare provider in these very rural areas, Klein said.

“It’s not surprising that having nurse practitioners be able to do this would increase access to buprenorphine in rural areas,” she said. “It was surprising the extent to which people were reliant on nurse practitioners for this service and that nurse practitioners were stepping up to the plate and providing it.”

Opioid addiction “continues to be an enormous public health crisis that claimed over 46,000 lives in 2018,” the study notes.

Implementation of the Comprehensive Addiction and Recovery Act in early 2017 was intended to expand availability of medication-assisted treatment, which includes prescribing buprenorphine in an office or clinic.

Klein said her study “offers a good opportunity to look at whether changing a law has an impact on patient care,” especially in little-studied frontier areas.

Said Klein, “This is one of the few studies that’s really looked at the impact of nurse practitioners in frontier areas. Most studies look at urban versus rural, but it’s important to consider frontier areas that are even more isolated and underserved, and the contribution nurse practitioners make to this very important aspect of health care.”

Study:The Geographic Impact of Buprenorphine Expansion to Nurse Practitioner Prescribers in Oregon,” by Tracy A. Klein, PhD; Jonah Geddes, MPH; and Daniel Hartung, PharmD, The Journal of Rural Health.

–Story by Addy Hatch