The Effect of Federal Policy Changes on Buprenorphine Prescribing in Massachusetts

Two federal policy changes were recently implemented to expand access to buprenorphine. Our objective was to determine whether these policies were associated with a change in the trend of buprenorphine prescribing in Massachusetts, specifically among specialists including emergency physicians (EPs).

The Massachusetts Prescription Drug Monitoring Program database was searched for buprenorphine prescription records between May 2020 and January 2024. Monthly counts of buprenorphine prescriptions were measured for 12-month pretime and posttime periods for each policy. Monthly prescriptions were stratified by specialties of interest, and interrupted time series analyses evaluated the impact.

There was no change in the total buprenorphine prescriptions per month (bppm) between the prepractice-guideline period compared with the postpractice-guideline period nor between the pre-no-X-waiver period compared with the post-no-X-waiver period in Massachusetts. Among EPs, there was no change in prepractice guideline (-9.9 bppm, 95% CI, -33.4 to 13.7) and a declining trend in the postpractice-guideline of 15.6 (95% CI, -27.9 to -3.4) fewer bppm. Among EPs, there was a declining trend of 17.8 (95% CI, -26.9 to -8.6) fewer bppm in the pre-no-X-waiver period, which flattened (5.7 bppm, 95% CI, -18.7 to 7.3) in the post-no-X-waiver period.

The analysis demonstrates that the 2 federal policy changes were not associated with a significant change in the trend of total buprenorphine prescriptions written monthly in Massachusetts. The magnitude of decline in monthly buprenorphine prescriptions among ED physicians may have been tempered by the elimination of the X-waiver.