Integrating X-waiver training for opioid use disorder into the nurse practitioner and physician assistant curricula

Starting in 2016, physician assistants (PAs) and Advanced Practice Registered Nurses could prescribe buprenorphine with an approved waiver, which improves health care through expansion of access to care, reduction of health care costs, and provision of high-quality care. This study addresses barriers to student NP's and PA's ability to prescribe buprenorphine by examining knowledge and attitudes toward prescribing medications for opioid use disorder (MOUD), subjective norms and perceived behavioral control surrounding prescribing MOUD, and the intention to prescribe MOUD among NPs and PAs. Participants were 120 students enrolled in the NP or PA program at 3 large universities in the southeastern United States. Before and after engagement in the 8-hour Waiver Training, participants completed a survey to obtain measures of knowledge, attitudes toward prescribing MOUD, subjective norms, perceived behavioral control, and intention to prescribe MOUD. Results demonstrated increased knowledge regarding MOUD and prescribing practices from pre- to post-training. Students reported being significantly more likely to prescribe buprenorphine, methadone, and naltrexone after completing the waiver training, as well as stronger attitudes that MOUD is beneficial, useful, good, effective, and relevant. Student subjective norms did not significantly change from pre- to post-training, although perceived control significantly increased. Incorporation of training and treatment of patients with MOUD is critical for continued increases in the number of waivered providers.