As a response to the opioid epidemic, federal and state efforts have been underway to expand buprenorphine treatment for opioid use disorder in hospitals and affiliated health systems.
But primary care physicians practicing in health systems receive waivers to prescribe at less than half the rate of those outside health systems, according to a new study by Indiana University.
"Increasing access to medication treatment is a critical public health priority to reducing opioid use disorder and overdose in this country," said study co-author Kosali Simon, the Herman B Wells professor in the O'Neill School of Public and Environmental Affairs at IU Bloomington. "However, people who need the treatment are not always receiving it."
Buprenorphine was approved by the FDA 20 years ago as an approach to treating opioid use disorder. It is the first medication to treat opioid dependency permitted to be prescribed or dispensed in physician offices. Physicians or psychiatrists must have a waiver to prescribe the medication and are initially restricted to treating 30 patients but can apply to increase their limit up to 275.
Researchers of the study, published in the Journal of Substance Abuse Treatment, used the SK&A database to look for primary care physicians and psychiatrists in California, Florida, Georgia, Maryland, Ohio, Rhode Island, Wisconsin and West Virginia who were linked to a list of waivered buprenorphine prescribers from the U.S. Drug Enforcement Agency.
According to the study, only 3.6 percent of primary care physicians affiliated with hospital health systems have waivers, compared to 8.2 percent of unaffiliated physicians. However, more hospital affiliated psychiatrists (33.2 percent) have waivers than their unaffiliated counterparts (26.2 percent). Physicians in a health system who did have waivers were also more likely to have only a 30-patient limit (70 percent) versus those outside the system (56 percent.)
"Our study findings reveal that waivered rates are disappointingly low across the board and are especially low among primary care physicians in health systems," Simon said. "This low waivered rate suggests that many primary care providers in health systems cannot provide a critical service to their patients with opioid use disorder."
Researchers also took a look at where physicians with waivers are practicing and found waivered physicians affiliated with health systems were less likely to practice in high-poverty areas (33 percent) than their unaffiliated counterparts (47 percent).
Having a connection between a physician who prescribes buprenorphine and a hospital or health system is important, Simon said, because it can help provide a continuum of care for patients, especially if they have experienced an overdose.
"We know that when a patient is being discharged from a hospital after an overdose is a very good opportunity to be referred to treatment," Simon said. "But if there is no primary care physician in the network of the hospital who can prescribe buprenorphine, we lose that opportunity."
Researchers recommend health systems increase access to buprenorphine treatment in their communities by creating incentives or mandates for more affiliated physicians to obtain a waiver.
"It is important for hospitals and health systems to develop some policy or system-based incentives to have more doctors receive the training and waivers to prescribe buprenorphine, especially given how effective buprenorphine is as a tool in addictions recovery," Simon said. "Low access to buprenorphine is compromising our ability to address the overdose epidemic."
Brendan Saloner, associate professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and LeeKai Lin, assistant professor at Tunghai University Department of Economics, who received his PhD in economics from IU, are co-authors of the study.