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12 Articles in Volume 21, Issue #2
Advanced Practice Matters with Theresa & Jeremy: MAT and the DATA Waiver Debate
Analgesics of the Future: The Potential of Vocacapsaicin Injections for Knee Pain
Authorities Update Opioid and Naloxone Prescribing Policies as Overdoses Soar
Autologous Adipose-Derived Biocellular (Stem Cell-Rich) Prolotherapy into Hoffa’s Fat Pad Improves Knee Osteoarthritis
Behavioral Medicine: How to Utilize Acceptance and Commitment Therapy in Primary Care
Case Report: How We Grew Our Pain Practice Amidst Pandemic, Opioid Crisis
Chronic Overlapping Pelvic Pain Disorders: Differential Diagnoses and Treatment
Fentanyl Transdermal Patch: Variability is Key When Prescribing
Optimizing Opioid Therapy with Pharmacogenetics
Research Insights: Advances in Shoulder Arthroplasty and Revision Surgery
Research Insights: How to Address Osteoarthritis Treatment Gaps in Women
Topical Anti-Inflammatories: Analgesic Options for Arthritis Beyond NSAIDs

Advanced Practice Matters with Theresa & Jeremy: MAT and the DATA Waiver Debate

Changing DATA waiver requirements affect advanced providers’ role in treating opioid use disorder.

Until recently, medication-assisted therapy (MAT), an evidence-based treatment for opioid use disorder (OUD), was restricted to physician prescribing only. Buprenorphine was approved for treating OUD in 2002 and thousands of physicians currently hold DATA-waivers to prescribe this treatment.1 Despite the lawful ability in most states for NPs and PAs to prescribe opioids for pain and other appropriate conditions, until 2016, they were prohibited from obtaining a DATA-waiver to prescribe buprenorphine for opioid addiction treatment.

There remains a significant unmet need for patient access to HCPs who have both the authority and ability to manage OUD. SAMHSA has estimated that in 2018, 2 million people age 12 and older had an OUD2 but that same year, the HHS Office of Inspector General found that 40% of communities in the US lacked any DATA-waived practitioners and, of the 1,100 counties assessed, 56% did not have the adequate capacity for providing MAT.3

In the midst of the opioid public health emergency, the CARA Act gave PAs and NPs the ability to temporarily receive a DATA-waiver and receive an “X-number,” as long as certain provisions were satisfied. Changing rules bring the waiver right into question. (Image: iStock)

MAT and Changing DATA Waiver Requirements

To step back just a bit, DATA waivers fall under the 2000 Drug Addiction Treatment Act, which allowed physicians to apply to prescribe buprenorphine for opioid addiction or opioid dependence outside of a formal opioid treatment program or recovery center (essentially, giving them a “waiver”). A congressionally mandated evaluation of the waiver program led by SAMHSA found that it increased availability of MAT, was safe and effective, and came with minimal public health consequences, adverse events, or diversion.

In the midst of the opioid public health emergency, the Comprehensive Addiction and Recovery Act of 2016 (CARA) gave PAs and NPs the ability to temporarily receive a DATA-waiver and receive an “X-number,” as long as certain provisions were satisfied.

The authorization in the CARA Act was set to expire on October 1, 2021, but in 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act)permanently secured the ability of PAs and NPs to become DATA-waived and practice as “qualifying practitioners” able to provide buprenorphine treatment for those with OUD.

The SUPPORT Act also established temporary authority for clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives to become DATA-waived. As of November 2020, the DEA reports that more than 18,000 PAs and NPs have become DATA-waived4 and evidence supports that these providers are serving to increase real access in the US. For example, in 2019, 285 rural counties identified that their first DATA-waived clinician was a PA or NP.5

The pathway for NPs and PAs to become DATA-waived qualified practitioners involves specific training on the treatment of OUD. Currently, these providers require a total of 24 hours of training and education.6,7 Although access to DATA-waived providers is improving, there are still a significant number of patients suffering from the harms of untreated opioid use disorders. From May 2019 to 2020, the year-over-year overdose deaths from opioids increased by 18% totaling 81,000 individuals.8 The COVID-19 pandemic has unfortunately contributed to keeping these numbers on the rise.

In an effort to overcome some of the barriers preventing practitioners from becoming DATA-waived, in January 2021, HHS authorized the removal of some of the requirements for physicians8 to treat OUD with buprenorphine. 

At the time of this writing, there was a petition* routing to improve access for Advanced Practice Providers. Further, both the American Association of Nurse Practitioners (AANP) and the American Academy of PAs (AAPA) expressed concerns9 that unilaterally making changes only to physician requirements could have an unintended consequence in decreasing the utilization of PAs and NPs and their authorized treatment of opioid use disorder. Many jurisdictions require DATA-waived NPs and PAs to have a relationship with a physician who is a DATA-waived “qualified practitioner” as an additional requirement for their prescribing of MAT.

Concern exists that by authorizing physicians to forgo the requirement to be DATA-waived, many NPs and PAs will inadvertently face challenges to their authority as DATA-waived providers when treating opioid use disorder. NPs and PAs may choose not to pursue DATA-waiver approval without clarity on their authority. We are hopeful that removing administrative barriers is a priority for all providers so increased access to MAT can be realized.

Editor's Note: HHS released updated buprenorphine prescribing and waiver guidelines in late April 2021. See our update on this issue.

In addition to the DATA-waiver requirements, state prescribing and scope of practice laws have been shown to have a direct impact on patient access to MAT provided by NPs and PAs. Throughout the country, state laws authorizing NP and PA practice vary considerably and, interestingly, the rate of DATA-waived NPs and PAs somewhat follows. For example, when comparing states with less restrictive to more restrictive provider practice laws, 75% more NPs obtained DATA-waivers in the states with fewer restrictions to practice.10

Summary

NPs and PAs serve an important role in combating the opioid crisis by providing and significantly increasing access to patients suffering from opioid use disorder. Recognizing the barriers these clinicians encounter and overcoming them can be accomplished. With enhanced understanding, and resolution of these challenges, more patients will benefit from access to these professionals.

Resources for APPs

*Disclaimer: PPM nor its publisher does not support any particular political view on this or other policy matters.

 
Last updated on: April 28, 2021
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Advanced Practice Matters with Theresa & Jeremy: COVID, Pain, and Power
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