Adoption of the 275-patient buprenorphine treatment waiver for treating opioid use disorder: A state-level longitudinal analysis

Abstract

Background: Increasing access to buprenorphine treatment is a critical tool for addressing the opioid epidemic in the United States. In 2016, a federal policy change allowed physicians who meet specific requirements to treat up to 275 concurrent buprenorphine patients. This study examines state-level measures of buprenorphine treatment supply over 21 months since this policy change and estimates associations between the supply of 275-patient waivers and state characteristics. Methods: Monthly state-level measures of the number of physicians holding the 275-patient waiver per 100,000 residents were constructed from September 2016 to May 2018 using the Drug Enforcement Agency’s Controlled Substance Act database. State characteristics were obtained from publicly available sources. Mixed-effects regression models were estimated to examine change over time. Results: During the 21-month period, the number of physicians waivered to treat 275 patients increased from 153 to 4009 physicians. The mean supply of 275-patient physicians per 100,000 state residents significantly increased from 0.07 (SD = 0.21) in September 2016 to 1.43 (SD = 1.08) in May 2018 (t = −9.84, df = 50, P < .001). The final mixed-effects regression model indicated that Census division and the preexisting supply of 100-patient waivered physicians were correlated with the rate of growth in 275-patient waivers over the study period. Conclusions: Although uptake of the 275-patient waiver has exceeded initial projections, growth is uneven across the United States. Unequal patterns of growth pose a challenge to efforts to increase treatment availability as a means of addressing the opioid epidemic.

Keywords:

• Buprenorphine
• DATA 2000
• opioid use disorder treatment

Disclosure

Michelle Lofwall has received contract funding for research from Braeburn Pharmaceuticals (which is developing a buprenorphine product), has consulted for Braeburn, CVS Caremark, and Indivior (which manufactures a buprenorphine product), and has received honoraria from PCM Scientific, which was the recipient of unrestricted educational grant funds from Reckitt Benckiser (now Indivior), that supported developing and presenting educational talks on opioid use disorder.

Author contributions

Hannah Knudsen conceived the research question, reviewed the literature, and analyzed the data. Lewei Lin and Michelle Lofwall contributed to the literature review and elaborated upon the discussion. All authors revised the manuscript and reviewed the final draft of the manuscript prior to submission.

Additional information

Funding

This research was supported by the National Institute on Drug Abuse (NIDA; grant R33DA035641) and use of REDCap was supported by the National Institutes of Health National Center for Advancing Translational Sciences (NIH NCATS; UL1TR000117). NIDA and NCATS had no further role in study design; data collection, analysis, or interpretation; manuscript preparation; or the decision to submit the manuscript. The content of this manuscript is solely the responsibility of the authors and does not represent the official views of NIH, NIDA, or NCATS.