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Nurse practitioner (NP) and physician assistant (PA) prescribing can increase access to buprenorphine treatment for opioid use disorder. In this cross-sectional study, we used deidentified claims from approximately 90% of U.S. retail pharmacies (2017–2018) to examine the association of state policies with the odds of receiving buprenorphine treatment from an NP/PA versus a physician, overall and stratified by urban/rural status. From 2017 to 2018, the percentage of buprenorphine treatment episodes prescribed by NPs/PAs varied widely across states, from 0.4% in Alabama to 57.2% in Montana. Policies associated with greater odds of buprenorphine treatment from an NP/PA included full scope of practice (SOP) for NPs, full SOP for PAs, Medicaid pay parity for NPs (reimbursement at 100% of the fee-for-service physician rate), and Medicaid expansion. Although most findings with respect to policies were similar in urban and rural settings, the association of Medicaid expansion with NP/PA buprenorphine treatment was driven by rural counties. [ABSTRACT FROM AUTHOR]

A national effort to provide more expansive mental health care in the United States has been an increasing priority during the last decade. States have enacted laws that allow for the delegation of psychiatric services to physician assistants in an effort to address the shortage and geographic maldistribution of mental health services and to more efficiently use the skills of psychiatrists. This statutory scheme recognizing physician assistants has been effective in broadening access to mental health care in various southern states. It also has, however, imposed certain risks and responsibilities upon psychiatrists who choose to supervise physician assistants. Understanding the regulatory responsibilities imposed upon supervising psychiatrists and anticipating the risks associated with supervising a physician assistant are important in avoiding grave financial consequences and the difficulties associated with litigation. Here, we review the statutory responsibilities imposed upon the psychiatrists supervising physician assistants across various southern states and to discuss the risk of vicarious liability of the psychiatrists for the actions of the physician assistants. [ABSTRACT FROM AUTHOR]