Drug overdose is now the leading cause of accidental death in the U.S., with over 60% of those overdose deaths involving an opioid, including heroin or pharmaceutical pain killer.
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This cap was put into place, in part, due to concerns about the possibility that the medication could be sold by patients to others to be used outside of medical supervision or for non-medical reasons (i.e., diversion). Capping physicians’ caseloads, many thought, would make medical supervision easier, and minimize the amount of buprenorphine that could potentially be misused or diverted.
Beginning in 2006, physicians were eligible to prescribe for 100 patients if they had the initial waiver for at least 1 year and were currently using medication-assisted treatment with buprenorphine in their practice (hereafter called 100-patient physicians).
Furthermore, some eligible physicians prescribe buprenorphine in a private outpatient office; others are staff at a substance use disorder (SUD) treatment program, or more specifically at a program that specializes in the treatment of opioid use disorder. This study by Stein et al. examined whether the availability of waivered physicians and SUD treatment programs is associated with the amount of buprenorphine prescribed.
Authors used data from three large, national datasets:
The primary independent variable was number of waivered physicians and buprenorphine-providing programs per 10,000 state residents (i.e., per capita). The primary outcome was amount of buprenorphine dispensed per capita by state each year. Analyses controlled for differences in state population, and several other state-level factors that authors did not specify explicitly.
Programs treating patients with buprenorphine also increased substantially between 2004 and 2011: From 246 to 1241, respectively, for substance use disorder (SUD) programs and from 71 to 348, respectively, for opioid-specific programs. Rates of waivered physicians in urban areas were greater than those in rural areas, though this difference declined somewhat over time (suggesting increased access in rural areas). Authors did not examine whether these differences were statistically significant.
The opposite pattern was observed for SUD and opioid-specific programs, where urban programs increased relative to rural programs. Regarding impact of provider availability, the 100-patient physicians appear to have the greatest impact on the amount of buprenorphine dispensed.
There was a significant association between the 100-patient physicians and buprenorphine dispensed for 2007-2011 in urban areas and 2008-2011 in rural areas. Specifically in 2011, each additional 100-patient physician was associated with 400 more grams of buprenorphine in urban areas and 500 more grams of buprenorphine in rural areas. The association between the 30-patient physicians and more buprenorphine dispensed was significant only for select years in rural areas.
Substance use disorder (SUD) and opioid-specific treatment program prescribing was not associated with buprenorphine prescribing. Below is a graph of the number of theoretical additional patients with access to buprenorphine provided by each additional physician or program in 2011, broken down by urban and rural areas. The calculation is based on a maximum buprenorphine dose (24 mg/day), and assumes a patient is in treatment for the entire year in the analysis (8.8 gram per year). In other words, the number of additional patients treated could be higher than these totals; these are conservative estimates.
These findings offer insights into the potential benefits of changing recovery-related health policies. They suggest that adding physicians waivered to prescribe buprenorphine to 100 patients at a time would offer the greatest increase in patients’ access to medication-assisted treatment with buprenorphine.
Importantly, for 2017 President Barack Obama’s budget includes $920 million earmarked to help states expand access to opioid use disorder treatment (see here). These data indicate that using these added financial resources to increase the number of 100-patient waivered physicians (e.g., with outreach and education to office-based physicians) might improve patient access to medication-assisted treatment with buprenorphine.
Results from this study can help inform decisions by policy makers in at least two ways:
From the finding that 100-patient physicians were associated with increases in the amount of buprenorphine dispensed, it follows that more 100-patient physicians will increase access to medication-assisted treatment with buprenorphine.
Also, while many studies show receiving buprenorphine is associated with better short-term abstinence, a recent study, also showed medication-assisted treatment with buprenorphine is associated with abstinence over the long term.
Increased access to medication-assisted treatment for individuals with opioid use disorder may be followed by increased rates of remission, and reduced opioid use disorder-related negative consequences (e.g., overdose deaths; risk of contracting Hepatitis C through sharing needles).
As mentioned earlier, one potentially fruitful next step would be to investigate whether an increase in 100-patient physicians is associated with an actual increase in the number of patients that engage with buprenorphine treatment.
In addition, many policy and law makers are advocating for raising the buprenorphine patient cap, or the removal of the cap altogether (see here). The impact of these policy changes, if and when they occur, should be examined empirically.
Stein, B. D., Pacula, R. L., Gordon, A. J., Burns, R. M., Leslie, D. L., Sorbero, M. J., . . . Dick, A. W. (2015). 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. Milbank Quarterly, 93(3), 561-583. doi: 10.1111/1468-0009.12137
l
This cap was put into place, in part, due to concerns about the possibility that the medication could be sold by patients to others to be used outside of medical supervision or for non-medical reasons (i.e., diversion). Capping physicians’ caseloads, many thought, would make medical supervision easier, and minimize the amount of buprenorphine that could potentially be misused or diverted.
Beginning in 2006, physicians were eligible to prescribe for 100 patients if they had the initial waiver for at least 1 year and were currently using medication-assisted treatment with buprenorphine in their practice (hereafter called 100-patient physicians).
Furthermore, some eligible physicians prescribe buprenorphine in a private outpatient office; others are staff at a substance use disorder (SUD) treatment program, or more specifically at a program that specializes in the treatment of opioid use disorder. This study by Stein et al. examined whether the availability of waivered physicians and SUD treatment programs is associated with the amount of buprenorphine prescribed.
Authors used data from three large, national datasets:
The primary independent variable was number of waivered physicians and buprenorphine-providing programs per 10,000 state residents (i.e., per capita). The primary outcome was amount of buprenorphine dispensed per capita by state each year. Analyses controlled for differences in state population, and several other state-level factors that authors did not specify explicitly.
Programs treating patients with buprenorphine also increased substantially between 2004 and 2011: From 246 to 1241, respectively, for substance use disorder (SUD) programs and from 71 to 348, respectively, for opioid-specific programs. Rates of waivered physicians in urban areas were greater than those in rural areas, though this difference declined somewhat over time (suggesting increased access in rural areas). Authors did not examine whether these differences were statistically significant.
The opposite pattern was observed for SUD and opioid-specific programs, where urban programs increased relative to rural programs. Regarding impact of provider availability, the 100-patient physicians appear to have the greatest impact on the amount of buprenorphine dispensed.
There was a significant association between the 100-patient physicians and buprenorphine dispensed for 2007-2011 in urban areas and 2008-2011 in rural areas. Specifically in 2011, each additional 100-patient physician was associated with 400 more grams of buprenorphine in urban areas and 500 more grams of buprenorphine in rural areas. The association between the 30-patient physicians and more buprenorphine dispensed was significant only for select years in rural areas.
Substance use disorder (SUD) and opioid-specific treatment program prescribing was not associated with buprenorphine prescribing. Below is a graph of the number of theoretical additional patients with access to buprenorphine provided by each additional physician or program in 2011, broken down by urban and rural areas. The calculation is based on a maximum buprenorphine dose (24 mg/day), and assumes a patient is in treatment for the entire year in the analysis (8.8 gram per year). In other words, the number of additional patients treated could be higher than these totals; these are conservative estimates.
These findings offer insights into the potential benefits of changing recovery-related health policies. They suggest that adding physicians waivered to prescribe buprenorphine to 100 patients at a time would offer the greatest increase in patients’ access to medication-assisted treatment with buprenorphine.
Importantly, for 2017 President Barack Obama’s budget includes $920 million earmarked to help states expand access to opioid use disorder treatment (see here). These data indicate that using these added financial resources to increase the number of 100-patient waivered physicians (e.g., with outreach and education to office-based physicians) might improve patient access to medication-assisted treatment with buprenorphine.
Results from this study can help inform decisions by policy makers in at least two ways:
From the finding that 100-patient physicians were associated with increases in the amount of buprenorphine dispensed, it follows that more 100-patient physicians will increase access to medication-assisted treatment with buprenorphine.
Also, while many studies show receiving buprenorphine is associated with better short-term abstinence, a recent study, also showed medication-assisted treatment with buprenorphine is associated with abstinence over the long term.
Increased access to medication-assisted treatment for individuals with opioid use disorder may be followed by increased rates of remission, and reduced opioid use disorder-related negative consequences (e.g., overdose deaths; risk of contracting Hepatitis C through sharing needles).
As mentioned earlier, one potentially fruitful next step would be to investigate whether an increase in 100-patient physicians is associated with an actual increase in the number of patients that engage with buprenorphine treatment.
In addition, many policy and law makers are advocating for raising the buprenorphine patient cap, or the removal of the cap altogether (see here). The impact of these policy changes, if and when they occur, should be examined empirically.
Stein, B. D., Pacula, R. L., Gordon, A. J., Burns, R. M., Leslie, D. L., Sorbero, M. J., . . . Dick, A. W. (2015). 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. Milbank Quarterly, 93(3), 561-583. doi: 10.1111/1468-0009.12137
l
This cap was put into place, in part, due to concerns about the possibility that the medication could be sold by patients to others to be used outside of medical supervision or for non-medical reasons (i.e., diversion). Capping physicians’ caseloads, many thought, would make medical supervision easier, and minimize the amount of buprenorphine that could potentially be misused or diverted.
Beginning in 2006, physicians were eligible to prescribe for 100 patients if they had the initial waiver for at least 1 year and were currently using medication-assisted treatment with buprenorphine in their practice (hereafter called 100-patient physicians).
Furthermore, some eligible physicians prescribe buprenorphine in a private outpatient office; others are staff at a substance use disorder (SUD) treatment program, or more specifically at a program that specializes in the treatment of opioid use disorder. This study by Stein et al. examined whether the availability of waivered physicians and SUD treatment programs is associated with the amount of buprenorphine prescribed.
Authors used data from three large, national datasets:
The primary independent variable was number of waivered physicians and buprenorphine-providing programs per 10,000 state residents (i.e., per capita). The primary outcome was amount of buprenorphine dispensed per capita by state each year. Analyses controlled for differences in state population, and several other state-level factors that authors did not specify explicitly.
Programs treating patients with buprenorphine also increased substantially between 2004 and 2011: From 246 to 1241, respectively, for substance use disorder (SUD) programs and from 71 to 348, respectively, for opioid-specific programs. Rates of waivered physicians in urban areas were greater than those in rural areas, though this difference declined somewhat over time (suggesting increased access in rural areas). Authors did not examine whether these differences were statistically significant.
The opposite pattern was observed for SUD and opioid-specific programs, where urban programs increased relative to rural programs. Regarding impact of provider availability, the 100-patient physicians appear to have the greatest impact on the amount of buprenorphine dispensed.
There was a significant association between the 100-patient physicians and buprenorphine dispensed for 2007-2011 in urban areas and 2008-2011 in rural areas. Specifically in 2011, each additional 100-patient physician was associated with 400 more grams of buprenorphine in urban areas and 500 more grams of buprenorphine in rural areas. The association between the 30-patient physicians and more buprenorphine dispensed was significant only for select years in rural areas.
Substance use disorder (SUD) and opioid-specific treatment program prescribing was not associated with buprenorphine prescribing. Below is a graph of the number of theoretical additional patients with access to buprenorphine provided by each additional physician or program in 2011, broken down by urban and rural areas. The calculation is based on a maximum buprenorphine dose (24 mg/day), and assumes a patient is in treatment for the entire year in the analysis (8.8 gram per year). In other words, the number of additional patients treated could be higher than these totals; these are conservative estimates.
These findings offer insights into the potential benefits of changing recovery-related health policies. They suggest that adding physicians waivered to prescribe buprenorphine to 100 patients at a time would offer the greatest increase in patients’ access to medication-assisted treatment with buprenorphine.
Importantly, for 2017 President Barack Obama’s budget includes $920 million earmarked to help states expand access to opioid use disorder treatment (see here). These data indicate that using these added financial resources to increase the number of 100-patient waivered physicians (e.g., with outreach and education to office-based physicians) might improve patient access to medication-assisted treatment with buprenorphine.
Results from this study can help inform decisions by policy makers in at least two ways:
From the finding that 100-patient physicians were associated with increases in the amount of buprenorphine dispensed, it follows that more 100-patient physicians will increase access to medication-assisted treatment with buprenorphine.
Also, while many studies show receiving buprenorphine is associated with better short-term abstinence, a recent study, also showed medication-assisted treatment with buprenorphine is associated with abstinence over the long term.
Increased access to medication-assisted treatment for individuals with opioid use disorder may be followed by increased rates of remission, and reduced opioid use disorder-related negative consequences (e.g., overdose deaths; risk of contracting Hepatitis C through sharing needles).
As mentioned earlier, one potentially fruitful next step would be to investigate whether an increase in 100-patient physicians is associated with an actual increase in the number of patients that engage with buprenorphine treatment.
In addition, many policy and law makers are advocating for raising the buprenorphine patient cap, or the removal of the cap altogether (see here). The impact of these policy changes, if and when they occur, should be examined empirically.
Stein, B. D., Pacula, R. L., Gordon, A. J., Burns, R. M., Leslie, D. L., Sorbero, M. J., . . . Dick, A. W. (2015). 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. Milbank Quarterly, 93(3), 561-583. doi: 10.1111/1468-0009.12137
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