Increased buprenorphine prescribing following implementation of a low-barrier virtual prescriber network

Rates of buprenorphine receipt have stagnated across the United States despite high overdose mortality and federal policy changes designed to increase prescribing. In March 2023, the city of Paterson, New Jersey (NJ) implemented RealFix, a municipal initiative focused on rapid induction and delivery of buprenorphine. RealFix uses a walk-in model and a virtual provider-hub service to reduce delays in MOUD initiation and lower barriers to treatment entry for patients, most of whom are insured through Medicaid. Using 2021-2025 NJ prescription drug monitoring program data, we measured changes in buprenorphine dispensing and secondarily, buprenorphine treatment retention in Paterson following the implementation of RealFix, versus matched comparators.

We used difference-in-differences models to compare Paterson with two control groups in the period prior to (2021-February 2023) and following (March 2023-2025) RealFix implementation: NJ cities with the highest naloxone administration rates by Emergency Medical Services (EMS) (n = 10) and cities matched on pre-intervention outcome trends (n = 15).

RealFix implementation was associated with significant increases in monthly buprenorphine dispensing of 66.5 (95% CI: 6.6-126.3) prescriptions per 10,000 relative to high-naloxone cities and 76.8 (31.6-121.9) relative to trend-matched cities. This represents a 14.6%-17.0% increase associated with RealFix, above and beyond secular trends captured by control groups. Associations with treatment retention were mixed, with no increases observed in high-naloxone cities and small, significant decreases relative to trend-matched cities.

RealFix was associated with increased buprenorphine dispensing relative to matched comparison cities, although changes in retention among new treatment initiators were mixed. These findings suggest that low-threshold, rapid-access models may expand buprenorphine access, while additional research is needed to understand their effects on longer-term treatment engagement.