title: Growth In Buprenorphine Waivers For Physicians Increased Potential Access To Opioid Agonist Treatment, 2002-11.
abstract: Opioid use disorders are a significant public health problem, affecting two million people in the United States. Treatment with buprenorphine, methadone, or both is predominantly offered in methadone clinics, yet many people do not receive the treatment they need. In 2002 the Food and Drug Administration approved buprenorphine for prescription by physicians who completed a course and received a waiver from the Drug Enforcement Administration, exempting them from requirements in the Controlled Substances Act. To determine the waiver program's impact on the availability of opioid agonist treatment, we analyzed data for the period 2002-11 to identify counties with opioid treatment shortages. We found that the percentage of counties with a shortage of waivered physicians fell sharply, from 98.9 percent in 2002 to 46.8 percent in 2011. As a result, the percentage of the US population residing in what we classified as opioid treatment shortage counties declined from 48.6 percent in 2002 to 10.4 percent in 2011. These findings suggest that the increase in waivered physicians has dramatically increased potential access to opioid agonist treatment. Policy makers should focus their efforts on further increasing the number and geographical distribution of physicians, particularly in more rural counties, where prescription opioid misuse is rapidly growing.
authors.affiliation: Andrew W. Dick is a senior economist at the RAND Corporation in Boston, Massachusetts.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Dick
authors.affiliation: Rosalie L. Pacula is a senior economist at RAND in Santa Monica, California.
authors.forename: Rosalie L
authors.initials: RL
authors.lastname: Pacula
authors.affiliation: Adam J. Gordon is an associate professor of medicine at the University of Pittsburgh School of Medicine and a staff physician in the Veterans Affairs Pittsburgh Healthcare System.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.affiliation: Mark Sorbero is a project associate at RAND in Pittsburgh.
authors.forename: Mark
authors.initials: M
authors.lastname: Sorbero
authors.affiliation: Rachel M. Burns is a project associate at RAND in Pittsburgh.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Burns
authors.affiliation: Douglas Leslie is a professor of public health sciences and psychiatry at the Penn State College of Medicine.
authors.forename: Douglas
authors.initials: D
authors.lastname: Leslie
authors.affiliation: Bradley D. Stein (stein@rand.org) is a senior natural scientist at RAND in Pittsburgh and an adjunct professor of psychiatry at the University of Pittsburgh School of Medicine.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Stein
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D061891:Controlled Substances; D011307:Drug Prescriptions; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence*; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010820:Physicians / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D012424:Rural Population; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D061891:Controlled Substances; D002047:Buprenorphine; D008691:Methadone
keywords: Access To Care; Mental Health/Substance Abuse; Physicians; Rural Health Care