State policy influence on the early diffusion of buprenorphine in community treatment programs.
BACKGROUND
Buprenorphine was approved for use in the treatment of opioid dependence in 2002, but its diffusion into everyday clinical practice in community-based treatment programs has been slow. This study examines the net impact of efforts by state agencies, including provision of Medicaid coverage, on program-level adoption of buprenorphine as of 2006.


METHODS
Interviews were conducted with key informants in 49 of the 50 state agencies with oversight responsibility for addiction treatment services. Information from these interviews was integrated with organizational data from the 2006 National Survey of Substance Abuse Treatment Services. A multivariate logistic regression model was estimated to identify the effects of state efforts to promote the use of this medication, net of a host of organizational characteristics.


RESULTS
The availability of Medicaid coverage for buprenorphine was a significant predictor of its adoption by treatment organizations.


CONCLUSIONS
Inclusion of buprenorphine on state Medicaid formularies appears to be a key element in ensuring that patients have access to this state-of-the-art treatment option. Other potential barriers to the diffusion of buprenorphine require identification, and the value of additional state-level policies to promote its use should be evaluated.
Institute for Behavioral Research, 111 Barrow Hall, University of Georgia, Athens, GA 30602, USA. lorid@uga.edu
Lori J
LJ
Ducharme
Amanda J
AJ
Abraham
D002047:Buprenorphine / Q000008:administration & dosage / Q000627:therapeutic use*; D003153:Community Health Services / Q000458:organization & administration*; D004059:Diffusion of Innovation; D005569:Formularies as Topic; D006291:Health Policy; D006801:Humans; D008484:Medicaid / Q000458:organization & administration; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D013219:State Government; D014481:United States
D009292:Narcotic Antagonists; D002047:Buprenorphine