Prescribing patterns of buprenorphine waivered physicians

Area of Science:

• Addiction Medicine
• Public Health Policy
• Pharmacotherapy

Background:

• DATA 2000 allowed waivered physicians to prescribe buprenorphine for opioid use disorder (OUD).
• A 2016 rule change increased the patient limit for some waivered physicians from 100 to 275.
• This study analyzes buprenorphine prescriber patterns based on waiver limits.

Purpose of the Study:

• To examine buprenorphine prescribing patterns among physicians with different patient limits.
• To assess the impact of prescriber waiver status on patient census and treatment duration.
• To inform policy regarding prescriber capacity and access to OUD treatment.

Main Methods:

• Utilized Prescription Monitoring Program (PMP) data from Ohio, California, and Maine (Jan 2010-Apr 2015).
• Identified buprenorphine prescriptions for OUD.
• Analyzed monthly patient censuses, treatment episode duration, and proximity to patient limits by prescriber waiver status.

Main Results:

• 8638 physicians initiated 468,148 buprenorphine episodes across three states.
• Adjusted mean monthly patient census: 42.9 (100-limit), 13.6 (30-limit), 7.6 (no waiver).
• 30-patient waivered physicians were more likely to have zero buprenorphine treatment episodes monthly.

Conclusions:

• Most buprenorphine prescribers operate below their patient limits.
• Increasing the maximum patient limit may enhance access for some, but broader impact requires complementary strategies.
• Physician capacity for OUD treatment needs multifaceted approaches beyond simply increasing patient limits.