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Member Research & Reports

Member Research & Reports

Kentucky: Expanding Physician Capacity to Prescribe Buprenorphine May Be One Key to Slowing the Opioid Epidemic

A new JAMA Network publication examines the question of whether the availability of buprenorphine-waivered physicians is associated with buprenorphine treatment use and prescription opioid use among Medicaid enrollees.

Dr. HeFei Wen of the University of Kentucky College of Public Health is the corresponding author of “Association of Buprenorphine-Waivered Physician Supply With Buprenorphine Treatment Use and Prescription Opioid Use in Medicaid Enrollees”. Co-authors are Dr. Jason Hockenberry of the Emory University Rollins School of Public Health and Dr. Harold Pollack of the University of Chicago School of Social Service Administration.

The authors note that the number of prescriptions for opioids in the United States quadrupled between 1999 and 2014, coinciding with a dramatic escalation in opioid addiction and opioid overdose deaths; this increase in prescriptions is considered a leading driver behind the nation’s opioid epidemic. Over the past decade, a concerted policy effort has been made to regulate opioid prescribing practices by strengthening prescription drug monitoring programs, regulating pain management clinics, and rescheduling hydrocodone combination products.

“However,” the authors write, “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. Thus, policies that complement supply-side restrictions are needed for tackling the underlying addictive behavior and addressing the ongoing epidemic.”

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.

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. A ten percent increase in the number of buprenorphine-waivered physicians was associated with an approximately ten percent increase in the Medicaid-covered buprenorphine prescribing rate and a 1.2 percent 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,” Dr. Wen et al. conclude.