Supply of buprenorphine waivered physicians: The influence of state policies

Highlights

• We examined the number of buprenorphine-waivered MDs in each county.

• 57% of US counties in 2011 had at least one waivered MD.

• Methadone clinics and illicit drugs were positively associated with waivered MDs.

• Counties with Medicaid coverage of buprenorphine had more waivered MDs.

• Policies should aim to increase waivered MDs in underserved areas.

Abstract

Buprenorphine, an effective opioid use disorder treatment, can be prescribed only by buprenorphine-waivered physicians. We calculated the number of buprenorphine-waivered physicians/100,000 county residents using 2008-11 Buprenorphine Waiver Notification System data, and used multivariate regression models to predict number of buprenorphine-waivered physicians/100,000 residents in a county as a function of county characteristics, state policies and efforts to promote buprenorphine use. In 2011, 43% of US counties had no buprenorphine-waivered physicians and 7% had 20 or more waivered physicians. Medicaid funding, opioid overdose deaths, and specific state guidance for office-based buprenorphine use were associated with more buprenorphine-waivered physicians, while encouraging methadone programs to promote buprenorphine use had no impact. Our findings provide important empirical information to individuals seeking to identify effective approaches to increase the number of physicians able to prescribe buprenorphine.