title: Buprenorphine physician supply: Relationship with state-level prescription opioid mortality.
abstract: Buprenorphine is an effective treatment for opioid use disorder but the supply of buprenorphine physicians is currently inadequate to address the nation's prescription opioid crisis. Perception of need due to rising opioid overdose rates is one possible reason for physicians to adopt buprenorphine. This study examined associations between rates of growth in buprenorphine physicians and prescription opioid overdose mortality rates in US states.
  
  
  
  The total buprenorphine physician supply and number of physicians approved to treat 100 patients (per 100,000 population) were measured from June 2013 to January 2016. States were divided into two groups: those with rates of prescription opioid overdose mortality in 2013 at or above the median (>5.5 deaths per 100,000 population) and those with rates below the median. State-level growth curves were estimated using mixed-effects regression to compare rates of growth between high and low overdose states.
  
  
  
  The total supply and the supply of 100-patient buprenorphine physicians grew significantly (total supply from 7.7 to 9.9 per 100,000 population, p<0.001; 100-patient supply from 2.2 to 3.4 per 100,000 population, p<0.001). Rates of growth were significantly greater in high overdose states when compared to low overdose states (total supply b=0.033, p<0.01; 100-patient b=0.022, p<0.01).
  
  
  
  The magnitude of the US prescription opioid crisis, as measured by the rate of prescription opioid overdose mortality, is associated with growth in the number of buprenorphine physicians. Because this observational design cannot establish causality, further research is needed to elucidate the factors influencing physicians' decisions to begin prescribing buprenorphine.
authors.affiliation: Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508, USA. Electronic address: hannah.knudsen@uky.edu.
authors.forename: Hannah K
authors.initials: HK
authors.lastname: Knudsen
authors.affiliation: Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 201, Lexington, KY 40508, USA. Electronic address: jennifer.havens@uky.edu.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Havens
authors.affiliation: Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 203 Lexington, KY 40508, USA. Electronic address: michelle.lofwall@uky.edu.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Lofwall
authors.affiliation: Department of Behavioral Science, University of Kentucky, 127 Medical Behavioral Science Building, Lexington, KY 40536-0086, USA. Electronic address: jamie.studts@uky.edu.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Studts
authors.affiliation: Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 202, Lexington, KY 40508, USA. Electronic address: sharon.walsh@uky.edu.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Walsh
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D002047:Buprenorphine / Q000600:supply & distribution* / Q000627:therapeutic use*; D062787:Drug Overdose / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000401:mortality*; D010820:Physicians / Q000600:supply & distribution*; D013223:Statistics as Topic; D014481:United States; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine
keywords: Buprenorphine; Physicians; Prescription opioid overdose; Treatment supply