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

Knudsen, Hannah K.

doi:10.15288/jsad.2015.76.644

Cited by 68 publications

(69 citation statements)

References 70 publications

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“…Though buprenorphine prescription has, to date, been strictly limited by law, researchers have called on lawmakers to consider relaxing such restrictions as they may contribute to greater patient harm [34]. Previous research has found a similar trend regarding the supply of waivered physicians in the northeast relative to other regions [35] and though some have offered explanations for this with respect to health care reform [36] or regional variations in opioid mortality [37], more research is needed to better understand the factors which have led to the relatively low uptake of buprenorphine treatment outside of the northeast. A number of general causes have been suggested as contributory towards the relatively low use of buprenorphine treatment, including a shortage of certified prescribers and worries about patient diversion [38,39] as well as insufficient prescriber knowledge about the use of opioid agonist therapy and potential stigma associated with its use [40].…”

Section: Discussionmentioning

confidence: 99%

Responses among substance abuse treatment providers to the opioid epidemic in the USA: Variations in buprenorphine and methadone treatment by geography, operational, and payment characteristics, 2007-16

2020

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ObjectiveTo identify the geographic, organisational, and payment correlates of buprenorphine and methadone treatment among substance abuse treatment (SAT) providers. MethodsSecondary analyses of the National Survey of Substance Abuse Treatment Services (NSSATS) from 2007-16 were conducted. We provide bivariate descriptive statistics regarding substance abuse treatment services which offered buprenorphine and methadone treatment from 2007-16. Using multiple logistic regression, we regressed geographic, organisational, and payment correlates on buprenorphine and methadone treatment.

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Section: Discussionmentioning

confidence: 99%

Responses among substance abuse treatment providers to the opioid epidemic in the USA: Variations in buprenorphine and methadone treatment by geography, operational, and payment characteristics, 2007-16

2020

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“…In addition, our findings may not be generalizable to other states that have implemented insurance expansions. Knudsen (2015) has shown that there are large regional differences in access to substance use disorder treatment, particularly in the supply of physicians waivered (e.g., permitted) to prescribe buprenorphine for the treatment of opioid use disorders. MA, with 18 buprenorphine-waivered physicians per 100,000 residents in 2013, has a much greater supply of waivered physicians than other states.…”

Section: Discussionmentioning

confidence: 99%

Massachusetts Health Reform's Effect on Hospitalizations with Substance Use Disorder–Related Diagnoses

Lasser

Hanchate

McCormick

et al. 2017

Health Services Research

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“…Insufficient numbers of providers for treatment of OUD have been noted as a significant barrier to the availability of such treatment. In a state-level analysis of the supply of physicians waivered to prescribe buprenorphine for OUD, Knudsen (2015) found that the average state had 8 waivered physicians per 100,000 residents. In addition, large regional differences were found between states in the Northeast and states in the Midwest, South, and West.…”

Section: Availability Of Providers and Treatmentmentioning

confidence: 99%

“…The supply of physicians waivered to prescribe buprenorphine was positively associated with the percentage of resi-322 PAIN MANAGEMENT AND THE OPIOID EPIDEMIC dents covered by Medicaid, the population-adjusted availability of opioid treatment programs, and the number of substance use disorder treatment programs. The supply of waivered physicians was positively correlated with states' numbers of overdose deaths, suggesting that physicians may seek waivers in response to the level of the opioid problem in their state (Knudsen, 2015). Recent steps to expand the number of waivered providers include increasing the upper limit of patients that can be treated by waivered physicians, expanding the type of prescribers permitted to be DATA 17 waivered, and integrating the required training into the health care professional educational curriculum (ASAM, 2016).…”

Section: Availability Of Providers and Treatmentmentioning

confidence: 99%

Pain Management and the Opioid Epidemic

Bonnie¹,

Ford²,

Phillips³

2017

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Years of sustained, coordinated, and vigilant effort will be required to contain the present opioid epidemic and ameliorate its harmful effects on society. At least 2 million people have an opioid use disorder (OUD) involving prescription opioids, and almost 600,000 have an OUD associated with heroin (HHS, 2016). These numbers are likely to increase in the coming years, regardless of what policies are put in place. Follow-up studies of individuals receiving treatment for OUD involving heroin (e.g., Hser et al., 2001) find very high rates of premature mortality (in the neighborhood of one-third) due to overdose or other complications of the disorder. Thus, even if the nation ramps up treatment availability substantially and immediately, death rates will climb and quality of life will be dramatically reduced for many people for years to come. Likewise, the continued progression of still more people from prescription opioid use to OUD will demand sustained and coordinated effort to establish and implement the scientifically grounded policies and clinical practices necessary to reshape prescribing practices and reduce the occurrence of new cases of prescription opioid-induced OUD. 1 What should be done to contain the opioid epidemic and to prevent new cases of iatrogenic addiction and associated overdose, death, and other harms? The purpose of this chapter is to review available evidence on strategies that have been used to address the problems of opioid misuse, OUD, 1 Vigilance will also be needed to reduce the risk of similar problems in the future with other classes of medications for which there exists demand for clinical uses other than the indicated conditions and/or active black markets for their resale. 269RCTs, however, are rare for policies that require implementation at the level of an entire jurisdiction, nor are they ethically permissible in many policy contexts. In the absence of RCTs, other sources of evidence are needed to estimate the counterfactual outcome distribution under different strategies. One such source of evidence is the collection of data on individuals who happen to receive the strategies of interest as part of their routine care, often from electronic health records. The so-called observational analyses based on such data are attempts to emulate the RCT that cannot be conducted (the target trial). In these observational analyses, however, the comparability of the groups receiving each strategy is not guaranteed. In the real world, for example, the restricted opioid prescription policy might more likely be applied to individuals visiting providers in urban health care settings who also received other interventions to reduce the risk of addiction. As a result, a direct comparison of the outcome distribution between those who received each strategy would be confounded by the concomitant interventions.Observational analyses attempt to eliminate bias due to confounding by adjusting for all measured prognostic factors that are distributed differentially between the groups. For example, the ...

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

Cited by 68 publications

References 70 publications

Responses among substance abuse treatment providers to the opioid epidemic in the USA: Variations in buprenorphine and methadone treatment by geography, operational, and payment characteristics, 2007-16

Responses among substance abuse treatment providers to the opioid epidemic in the USA: Variations in buprenorphine and methadone treatment by geography, operational, and payment characteristics, 2007-16

Massachusetts Health Reform's Effect on Hospitalizations with Substance Use Disorder–Related Diagnoses

Pain Management and the Opioid Epidemic

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