Comparing Buprenorphine Treatment Outcomes Among Kentucky Medicaid Patients by Prescriber Specialty and Type

Buprenorphine is vital to improving health outcomes for patients with opioid use disorder (OUD). Little is known about variation in buprenorphine retention and related outcomes across different outpatient prescribers and settings.

Our 2020-2021 sample includes 10,709 Kentucky Medicaid-enrolled patients with OUD who received most of their buprenorphine prescriptions from primary care physicians, specialty care physicians, or advanced practice providers (APP). Adjusted multivariable linear and logistic regression, respectively, estimated the percentage of days with buprenorphine coverage and the proportion of patients who experienced non-fatal overdose after the first prescription.

Compared to specialty physicians and APPs, those with primary care prescribers had a higher percentage of days with buprenorphine (primary: 69.6, 95% confidence interval (CI): [66.7, 72.4]; specialty: 60.1, 95% CI: [54.7, 65.4]; APP: 64.3, 95% CI: [62.1, 66.5]; p < 0.01). A lower proportion of patients with APP prescribers experienced non-fatal overdose (APP: 4.0, 95% CI: [3.4, 4.7]; primary: 5.5, 95% CI: [4.1, 6.9]; specialty: 5.7, 95% CI: [4.2, 7.2]; p < 0.01).

Kentucky Medicaid-enrolled patients with primary care physicians had the highest treatment retention, while patients with APPs were less likely to experience a non-fatal overdose. Our findings suggest that although multiple provider types can effectively prescribe buprenorphine, the potentially meaningful differences observed in retention and non-fatal overdose warrant further longitudinal investigation to assess whether these differences by provider type and setting persist over time.