title: 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.
authors.affiliation: RAND Corporation, Pittsburgh, PA, USA; University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213. Electronic address: stein@rand.org.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Stein
authors.affiliation: University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA 15261.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.affiliation: RAND Corporation, Pittsburgh, PA, USA.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
authors.affiliation: RAND Corporation, Pittsburgh, PA, USA.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Burns
authors.affiliation: RAND Corporation, Pittsburgh, PA, USA.
authors.forename: Rosalie Liccardo
authors.initials: RL
authors.lastname: Pacula
authors.affiliation: RAND Corporation, Pittsburgh, PA, USA.
authors.forename: Carrie M
authors.initials: CM
authors.lastname: Farmer
authors.affiliation: Penn State College of Medicine, 90 Hope Drive, Hershey, PA 17033.
authors.forename: Douglas L
authors.initials: DL
authors.lastname: Leslie
authors.affiliation: RAND Corporation, Pittsburgh, PA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Sorbero
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D008484:Medicaid / Q000706:statistics & numerical data; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data*; D010820:Physicians / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D011640:Public Policy / Q000331:legislation & jurisprudence*; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone
keywords: Buprenorphine; Medicaid; Medication assisted treatment; Opioid use disorder; State policy