Availability of Buprenorphine Treatment in the 10 States With the Highest Drug Overdose Death Rates in the United States

Abstract

Objective: The objective of this study was to assess the accuracy of the Substance Abuse and Mental Health Services Administration (SAMHSA) database for patients who use it to seek buprenorphine treatment. Design and Measurements: Buprenorphine providers within a 25-mile radius of the county with the highest drug-related death rates within the 10 states with the highest drug-related death rates were identified and called to determine whether the provider worked there, prescribed buprenorphine, accepted insurance, had appointments, or charged for visits. Results: The number of providers listed in each county ranged from 1 to 166, with 5 counties having <10 providers. In 3 counties no appointments were obtained, and another 3 counties had ≤3 providers with availability. Of the 505 providers listed, 355 providers (70.3%) were reached, 310 (61.4%) of the 505 listings were correct numbers, and 195 (38.6%) of the 505 providers in the listings provided buprenorphine. Of the 173 clinics that provided buprenorphine and were asked about insurance, 131 (75.7%) accepted insurance. Of the 167 clinics that provided buprenorphine and were asked about Medicaid, 105 (62.9%) accepted it. Wait times for appointments ranged from 1 to 120 days, with an average of 16.8 days for those that had a waitlist. Among the 39 providers who reported out-of-pocket costs, the average cost was $231 (range: $90 to $600). One hundred forty of the 505 providers listed in the database had appointments available (27.7%). Three hundred sixty-five of the 505 providers did not have appointments available (72.3%) for various reasons, including the fact that 120 providers (32.9% of the 365 providers) could not be reached, and 137 of the numbers (37.5% of the 365 listed numbers) were wrong. Other reasons appointments could not be obtained included the fact that providers did not treat outpatients, were not accepting new patients, were out of office, or required a referral. Conclusion: Although the SAMHSA buprenorphine practitioner locator is used by patients and providers to locate treatment options, only a small portion of clinicians in the database ultimately offered initial appointments, implying that the database is only marginally useful for patients.

An examination of telehealth policy impacts on initial rural opioid use disorder treatment patterns during the COVID‐19 pandemic

“…Based on the projected increase in demand for MOUD services during COVID and the policy changes to allow MOUD to be administered via telehealth, we anticipate increases in the number of total visits and the number of new patients seen during COVID. Further, expanded availability of telehealth for treating OUD may increase access to these services, especially in remote or rural areas where providers with the required credentials, such as the DEA “X”‐waiver, have historically been scarce 11–14 . As such, we expect to see an increase in the use of MOUD services by patients from rural areas after the COVID‐related changes; however, it is also known that Internet and mobile phone service coverage are each more limited in rural areas, making it unclear to what extent people in rural areas who could benefit from telehealth‐provided MOUD will be able to access this modality 15 .…”

Who Gets Medication-assisted Treatment for Opioid Use Disorder, and Does It Reduce Overdose Risk? Evidence from the Rhode Island All-payer Claims Database

“…However, prescribers approved to treat as many as 275 patients with buprenorphine need to renew that elevated patient limit every three years or revert to a lower patient limit. 87 In addition to Flavin et al 2020, see also Lila Flavin and J. Wesley Boyd, "A Government Database Is Supposed to Help People Seeking Treatment for Opioid Addiction. It Often Doesn't," STAT News, January 9, 2020.…”

“…Previous research identifies disparities in the supply of buprenorphine providers between urban and rural areas (Andrilla et al 2018), although we find no association between living in a rural area and being treated with either methadone or buprenorphine. However, information on the practice locations of buprenorphine providers is known to be inaccurate (Flavin et al 2020). 91 Accordingly, policymakers might work to enhance the accuracy of treatment location information so that they can better assess which communities 91 See also Lila Flavin and J. Wesley Boyd, "A Government Database Is Supposed to Help People Seeking Treatment for Opioid Addiction.…”

“…The retail price of Suboxone, a popular formulation of buprenorphine, runs from $6 to $24 per day. 17 Even when insurance covers MAT, some providers choose not to accept patients with some types of insurance (often Medicaid) due to inadequate reimbursement rates, and some refuse to accept any form of health insurance (Knudsen and Studts 2019;Flavin et al 2020). Many states, including Rhode Island, offer targeted subsidies for methadone to uninsured residents, although such subsidies are not on par with comprehensive health insurance benefits for substance abuse treatment.…”

“…85 Based on any of those reasons, access to buprenorphine might be less than what is indicated by the official tally of waivered prescribers. 86 Separate research (Flavin et al 2020) finds that of the prescribers listed in SAMHSA's buprenorphine treatment locator in 2019 and practicing in any of 10 states including Rhode Island, 30 percent could not be reached by phone after repeated attempts, and more than onequarter of those that were contacted had stopped prescribing buprenorphine. The same study finds that large shares of active providers do not accept either Medicaid or private health insurance.…”