Supply of buprenorphine waivered physicians: The influence of state policies

Abstract

Buprenorphine, an effective opioid use disorder treatment, can be prescribed only by buprenorphine-waivered physicians. We calculated the number of buprenorphine-waivered physicians/100,000 county residents using 2008–11 Buprenorphine Waiver Notification System data, and used multivariate regression models to predict number of buprenorphine-waivered physicians/100,000 residents in a county as a function of county characteristics, state policies and efforts to promote buprenorphine use. In 2011, 43% of US counties had no buprenorphine-waivered physicians and 7% had 20 or more waivered physicians. Medicaid funding, opioid overdose deaths, and specific state guidance for office-based buprenorphine use were associated with more buprenorphine-waivered physicians, while encouraging methadone programs to promote buprenorphine use had no impact. Our findings provide important empirical information to individuals seeking to identify effective approaches to increase the number of physicians able to prescribe buprenorphine.

The Supply of Physicians Waivered to Prescribe Buprenorphine for Opioid Use Disorders in the United States: A State-Level Analysis

“…The differences between the Northeast and the other three regions were somewhat reduced by the addition of other state characteristics, but still considerable. In contrast to the two studies of county-level supply (Rosenblatt et al, 2015;Stein et al, 2015), this state-level analysis did not fi nd signifi cant differences by population density or the percentage of residents living in rural areas. It may be that county-level differences between rural and urban areas do not extrapolate to macrolevel differences between states.…”

“…Information regarding buprenorphine waivers is maintained in the Drug Enforcement Agency's Controlled Substances Act (CSA) Registrants database. In the fi rst year after FDA approval, about 2,000 physicians applied for the buprenorphine waiver (Kissin et al, 2006), which had increased to more than 20,000 physicians holding the waiver by 2011 (Stein et al, 2015).…”

“…Stein et al (2015) examined the supply of waivered physicians in U.S. counties from 2008 to 2011 as a function of state policies and county characteristics. Rosenblatt et al (2015) compared the supply of waivered physicians in counties by rural-urban status and then mapped the counties with at least one provider in mid-2012.…”

Policies to Support a Better Treatment for Heroin and Prescription Opioid Abuse: Unlike Methadone, Buprenorphine Can Be Taken at Home, but Greater Access is Key

“…Summary: Several policies are associated with a robust supply of waivered physicians, according to "Supply of Buprenorphine Waivered Physicians: The Influence of State Policies" (Stein et al, 2015a).…”

Integrating Policy and Research into Addiction Practice, AMERSA Abstracts, and an Appreciation to Our Reviewers

“…In the addiction field, this could apply to such topics as the impact of the Parity Laws and Affordable Care Act on access to and quality of addiction treatment [3][4][5][6] and the impact of buprenorphine regulations and policies. [7][8][9][10] For lack of a better term, research that directly examines the influence of policy or regulations on clinical care can be defined as applied regulation and policy examination and research (ARPER). Along with research that informs stakeholders about the current evidence-based approaches to addiction-related care or public health, ARPER has an important role to play in addiction-related care and public health.…”