Adherence to buprenorphine treatment guidelines among individuals with an opioid use disorder who have private insurance

Abstract

BackgroundAlthough treatment of opioid use disorders (OUD) with medications is expanding, the extent to which practitioners are prescribing medications following best practices has received little attention. ObjectiveThe aim of this study was to determine the extent to which privately insured patients being treated for OUD with buprenorphine were treated in a manner consistent with practice guidelines. DesignLongitudinal analyses of a large commercial claims dataset from 2012 to 2016. ParticipantsWe analyzed data for 38,517 patients with an OUD diagnosis continuously enrolled for 3 months prior to and 6 months after an initial buprenorphine or buprenorphine–naloxone prescription fill. Main measuresWe evaluated whether practitioners tested patients for hepatitis B, hepatitis C, HIV, and liver function; how often they received urine drug screens; the frequency of outpatient visits; and the extent to which they filled prescriptions for buprenorphine for at least 6 months. Key resultsPractitioners tested approximately 4.7% of patients for hepatitis B, 6.5% for hepatitis C, and 29.3% for HIV; they tested 8.0% for liver functioning; and gave 33.3% urine drug tests. Approximately 76% of patients had at least one outpatient visit for their OUD. Among those with at least one visit, the mean number of visits was 7.38. After the initial prescription, 47.5% stayed on buprenorphine for at least 6 months. ConclusionsA large portion of privately insured patients receiving buprenorphine for OUD did not receive care consistent with guidelines.