Where Is Buprenorphine Dispensed to Treat Opioid Use Disorders? The Role of Private Offices, Opioid Treatment Programs, and Substance Abuse Treatment Facilities in Urban and Rural Counties.
CONCLUSIONS
Buprenorphine is an effective opioid dependence treatment that has expanded access to care since its 2002 approval, but it can only be prescribed by physicians waivered to treat a limited number of individuals. We examined the impact of 2006 legislation that increased waivered physician patient limits from 30 to 100 on buprenorphine use, and found that 100-patient-waivered physicians were significantly associated with growth in buprenorphine use, with no such relationship for 30-patient-waivered physicians. Policies relaxing patient limits may be more effective in increasing buprenorphine use than alternatives such as opening new substance abuse treatment facilities or increasing the overall number of waivered physicians.


BACKGROUND
Opioid use disorders are a significant public health problem. In 2002, the FDA approved buprenorphine as an opioid use disorder treatment when prescribed by waivered physicians who were limited to treating 30 patients at a time. In 2006, federal legislation raised this number to 100 patients. Although federal legislators are considering increasing these limits further and expanding prescribing privileges to nonphysicians, little information is available regarding the impact of such changes on buprenorphine use. We therefore examined the impact of the 2006 legislation-as well as the association between urban and rural waivered physicians, opioid treatment programs, and substance abuse treatment facilities-on buprenorphine distributed per capita over the past decade.


METHODS
Using 2004-2011 state-level data on buprenorphine dispensed and county-level data on the number of buprenorphine-waivered physicians and substance abuse treatment facilities using buprenorphine, we estimated a multivariate ordinary least squares regression model with state fixed effects of a state's annual total buprenorphine dispensed per capita as a function of the state's number of buprenorphine providers.


RESULTS
The amount of buprenorphine dispensed has been increasing at a greater rate than the number of buprenorphine providers. The number of physicians waivered to treat 100 patients with buprenorphine in both rural and urban settings was significantly associated with increased amounts of buprenorphine dispensed per capita. There was no significant association in the growth of buprenorphine distributed and the number of physicians with 30-patient waivers.


CONCLUSIONS
The greater amounts of buprenorphine dispensed are consistent with the potentially greater use of opioid agonists for opioid use disorder treatment, though they also make their misuse more likely. The changes after the 2006 legislation suggest that policies focused on increasing the number of patients that a single waivered physician could safely and effectively treat could be more effective in increasing buprenorphine use than would alternatives such as opening new substance abuse treatment facilities or raising the overall number of waivered physicians.
RAND Corporation.|University of Pittsburgh School of Medicine.
Bradley D
BD
Stein
RAND Corporation.
Rosalie Liccardo
RL
Pacula
University of Pittsburgh School of Medicine.|VA Pittsburgh Healthcare System.
Adam J
AJ
Gordon
RAND Corporation.
Rachel M
RM
Burns
Penn State College of Medicine.
Douglas L
DL
Leslie
RAND Corporation.
Mark J
MJ
Sorbero
RAND Corporation.
Sebastian
S
Bauhoff
Community Substance Abuse Centers.
Todd W
TW
Mandell
RAND Corporation.
Andrew W
AW
Dick
D002047:Buprenorphine / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence*; D006801:Humans; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data*; D010820:Physicians / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D011331:Private Practice; D011640:Public Policy / Q000331:legislation & jurisprudence; D019035:Rural Health Services / Q000706:statistics & numerical data*; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000517:prevention & control*; D014481:United States; D019037:Urban Health Services / Q000706:statistics & numerical data*
D009292:Narcotic Antagonists; D002047:Buprenorphine
buprenorphine; health policy; opioid-related disorders; substance abuse treatment