Abstract
Expanding treatment for opioid addiction has been recognized as an essential component of a comprehensive national response to the opioid epidemic. The Drug Addiction Treatment Act and its amendments attempted to improve access to treatment by involving office-based physicians in the provision of buprenorphine treatment. To estimate the association of availability of buprenorphine-waivered physicians with buprenorphine treatment use and, secondarily, with prescription opioid use among Medicaid enrollees. This economic evaluation study used state-level panel data analysis to estimate the association between the number of buprenorphine-waivered physicians and the Medicaid-covered buprenorphine prescribing rate and opioid prescribing rate among Medicaid fee-for-service and managed care enrollees throughout the United States between January 1, 2011, and December 31, 2016. Buprenorphine prescribing rate and opioid prescribing rate, measured as the number of buprenorphine prescriptions and opioid prescriptions covered by Medicaid on a quarterly basis per 1000 enrollees. The sample included 1059 quarterly observations. Two additional 100-patient-waivered physicians per 1 000 000 residents (approximately a 10% increase) were associated with an increase in the quarterly number of Medicaid-covered buprenorphine prescriptions of 0.46 (95% CI, 0.24-0.67) per 1000 enrollees and a reduction in the quarterly number of opioid prescriptions of 1.01 (95% CI, -1.87 to -0.15) per 1000 enrollees. Furthermore, 5 additional 30-patient-waivered physicians per 1 000 000 residents (approximately a 10% increase) were associated with an increase in the quarterly number of Medicaid-covered buprenorphine prescriptions of 0.37 (95% CI, 0.22-0.52) per 1000 enrollees and a reduction in the quarterly number of opioid prescriptions of 0.96 (95% CI, -1.85 to -0.07) per 1000 enrollees. A 10% increase in the number of buprenorphine-waivered physicians was associated with an approximately 10% increase in the Medicaid-covered buprenorphine prescribing rate and a 1.2% reduction in the opioid prescribing rate. Expanding capacity for buprenorphine treatment holds the potential to improve access to opioid addiction treatment, which may further reduce prescription opioid use and slow the ongoing opioid epidemic in the United States.
Highlights
IntroductionThe number of prescriptions for opioids in the United States quadrupled between 1999 and 2014.1 This increase in opioid prescriptions coincided with a dramatic escalation in opioid addiction and opioid overdose deaths and is considered a leading driver behind the nation’s opioid epidemic.[2,3] A concerted policy effort has been made over the past decade to regulate opioid prescribing practices by strengthening prescription drug monitoring programs (PDMPs), regulating pain management clinics, and rescheduling hydrocodone combination products.[4,5] restricting legal channels of prescription opioids may have the unintended consequence of pushing those already addicted to opioids to seek alternative, often illegal and more dangerous, drugs and sources.[6,7,8] policies that complement supply-side restrictions are needed for tackling the underlying addictive behavior and addressing the ongoing epidemic.[9]With respect to opioid addiction treatment, medications such as methadone, buprenorphine (including buprenorphine-naloxone), levacetylmethadol, and naltrexone have been approved by the US Food and Drug Administration (FDA) and proven effective in managing withdrawal symptoms and reducing the potential for relapse.[10,11,12] most people living with opioid addiction and seeking treatment have not received the treatment recommended for their condition because of the lack of system capacity for providing the treatment.[13]
With respect to opioid addiction treatment, medications such as methadone, buprenorphine, levacetylmethadol, and naltrexone have been approved by the US Food and Drug Administration (FDA) and proven effective in managing withdrawal symptoms and reducing the potential for relapse.[10,11,12]
Using Medicaid prescription and spending data between 2011 and 2016, our study provides some of the first estimates we know of for the population-level associations between the availability of buprenorphine-waivered physicians and increasing buprenorphine treatment use and, secondarily, reducing prescription opioid use by Medicaid enrollees
Summary
The number of prescriptions for opioids in the United States quadrupled between 1999 and 2014.1 This increase in opioid prescriptions coincided with a dramatic escalation in opioid addiction and opioid overdose deaths and is considered a leading driver behind the nation’s opioid epidemic.[2,3] A concerted policy effort has been made over the past decade to regulate opioid prescribing practices by strengthening prescription drug monitoring programs (PDMPs), regulating pain management clinics, and rescheduling hydrocodone combination products.[4,5] restricting legal channels of prescription opioids may have the unintended consequence of pushing those already addicted to opioids to seek alternative, often illegal and more dangerous, drugs and sources.[6,7,8] policies that complement supply-side restrictions are needed for tackling the underlying addictive behavior and addressing the ongoing epidemic.[9]With respect to opioid addiction treatment, medications such as methadone, buprenorphine (including buprenorphine-naloxone), levacetylmethadol, and naltrexone have been approved by the US Food and Drug Administration (FDA) and proven effective in managing withdrawal symptoms and reducing the potential for relapse.[10,11,12] most people living with opioid addiction and seeking treatment have not received the treatment recommended for their condition because of the lack of system capacity for providing the treatment.[13].
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