Nurse practitioner and physician assistant interest in
Robert J. Roose, (M.D., M.P.H.)
, Hillary V. Kunins, (M.D., M.P.H., M.S.)
Nancy L. Sohler, (Ph.D., M.P.H.)
, Rashiah T. Elam, (M.D.)
, Chinazo O. Cunningham, (M.D.)
Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
City University of New York Medical School, New York, NY, USA
Received 21 March 2007; received in revised form 4 May 2007; accepted 22 May 2007
Office-based buprenorphine places health care providers in a unique position to combine HIV and drug treatment in the primary care
setting. However, federal legislation restricts nurse practitioners (NPs) and physician assistants (PAs) from prescribing buprenorphine, which
may limit its potential for uptake and inhibit the role of these nonphysician providers in delivering drug addiction treatment to patients with
HIV. This study aimed to examine the level of interest in prescribing buprenorphine among nonphysician providers. We anonymously
surveyed providers attending HIV educational conferences in six large U.S. cities about their interest in prescribing buprenorphine. Overall,
48.6% (n = 92) of nonphysician providers were interested in prescribing buprenorphine. Compared to infectious disease specialists,
nonphysician providers (adjusted odds ratio [AOR] = 2.89, 95% confidence interval [CI] = 1.22–6.83) and generalist physicians (AOR =
2.04, 95% CI = 1.09–3.84) were significantly more likely to be interested in prescribing buprenorphine. NPs and PAs are interested in
prescribing buprenorphine. To improve uptake of buprenorphine in HIV settings, the implications of permitting nonphysician providers to
prescribe buprenorphine should be further explored. D 2008 Elsevier Inc. All rights reserved.
Keywords: Buprenorphine; Opioid dependence; Substance abuse; HIV; Nurse practitioners
In the United States, different types of providers deliver
HIV care. In addition to infectious disease specialists,
general internists and family physicians often care for
people with HIV. Nurse practitioners (NPs) and physician
assistants (PAs) also deliver HIV care as part of a
multidisciplinary team or as independent providers. As a
substantial proportion of HIV-infected individuals are drug
users (Bing et al., 2001; Centers for Disease Control and
Prevention, 2003, 2005), the recent approval of buprenor-
phine for the office-based treatment of opioid dependence
places providers in a unique position to combine HIV and
drug treatment in the primary care setting (Altice et al.,
2006; Sullivan & Fiellin, 2005). There is evidence to
suggest that the integration of HIV and drug treatment can
improve outcomes for both conditions (Sullivan, Metzger,
Fudala, & Fiellin, 2005).
However, although NPs and PAs have been shown to
provide high-quality HIV care (Wilson et al., 2005) and can
prescribe other controlled substances in most states (United
States Department of Justice, 2006), federal legislation
restricts them from becoming certified to prescribe bupre-
norphine. There is concern that this restriction is limiting
potential buprenorphine uptake and inhibiting the role of
NPs and PAs in delivering drug addiction treatment to
patients with HIV.
The role of these nonphysician providers in the United
States has increased dramatically in the last decade.
Between 1994 and 2004, the annual number of outpatient
visits treated by a nonphysician provider increased by 39%,
0740-5472/08/$ – see front matter D 2008 Elsevier Inc. All rights reserved.
4 Corresponding author. Montefiore Medical Center, Department of
Family and Social Medicine, 3544 Jerome Ave., 2nd Floor, Bronx, NY
10467, USA. Tel.: +1 917 605 2995.
E-mail address: email@example.com (R.J. Roose).
Journal of Substance Abuse Treatment 34 (2008) 456 – 459