Benefits of Increasing the Number of Buprenorphine-Waivered Physicians

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A state-level panel data analysis was performed using deidentified state drug utilization data from the Centers for Medicare & Medicaid Services.
A state-level panel data analysis was performed using deidentified state drug utilization data from the Centers for Medicare & Medicaid Services.

Increasing the number of buprenorphine-waivered physicians may facilitate access to buprenorphine and contribute to reducing the use of prescription opioids, according to a study published in JAMA Network Open.

A state-level panel data analysis was performed using deidentified state drug utilization data from the Centers for Medicare & Medicaid Services to examine the association between the number of buprenorphine-waivered physicians and the rate of opioid prescriptions, as well as the rate of Medicaid-covered buprenorphine prescribing among Medicaid fee-for-service and managed care enrollees. The primary outcomes were buprenorphine and opioid prescribing rates (ie, quarterly buprenorphine and opioid prescriptions per 1000 Medicaid enrollees; 1059 quarterly observations).

The addition of 2 physicians waivered to treat 100 patients/1,000,000 residents (corresponding to an increase of approximately 10%) was associated with increases in the number of Medicaid-covered buprenorphine prescriptions of 0.46/quarter/1000 enrollees (95% CI, 0.24-0.67) and a reduction in the number of opioid prescriptions per quarter of 1.01/1000 Medicaid enrollees (95% CI, −1.87 to −0.15).

The addition of 5 physicians waivered to treat 30 patients/1,000,000 residents (corresponding to an increase of approximately 10%) was associated with a rise in the number of Medicaid-covered buprenorphine prescriptions of 0.37/1000 enrollees (95% CI, 0.22-0.52) and a reduction in the number of opioid prescriptions of 0.96/1000 enrollees (95% CI, −1.85 to −0.07). A 10% increase in the number of buprenorphine-waivered physicians was associated with an approximately 10% increase in buprenorphine prescribing rate and a 1.2% reduction in opioid prescribing rate.

Limitations of the analysis include the reliance on data for only Medicaid-covered opioid prescriptions and lack of information on formulation variations and dosages, as well as the observational design.

"Our findings suggest that expanding treatment capacity for buprenorphine holds the potential to improve access to opioid addiction treatment, which may further reduce prescription opioid use and help slow the ongoing opioid epidemic in the United States," concluded the study authors.

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Reference

Wen H, Hockenberry JM, Pollack HA. Association of buprenorphine-waivered physician supply with buprenorphine treatment use and prescription opioid use in Medicaid enrollees. JAMA Network Open. 2018;1(5):e182943. doi: 10.1001/jamanetworkopen.2018.2943

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