Increasing Access to Medications for Opioid Use Disorder

Session Submission Type: Panel

Abstract

The U.S. opioid crisis continues to expose substantial gaps in access to and retention in evidence-based treatment for opioid use disorder (OUD), particularly medications for opioid use disorder (MOUD). Despite a growing policy focus on expanding treatment capacity, fewer than one in five individuals with OUD receive MOUD annually. This panel brings together four complementary papers that examine distinct but interrelated constraints on OUD treatment—patient-provider interactions, regulatory barriers, healthcare infrastructure, and pharmaceutical market forces—using quasi-experimental and causal inference methods. The first paper studies how patient-provider racial concordance affects inpatient outcomes among patients with OUD. Leveraging quasi-random assignment of hospitalists in Medicare data, the study finds that racial concordance significantly reduces discharge against medical advice (AMA), particularly among patients with prior OUD diagnoses and those receiving MOUD. These findings highlight the role of provider-patient matching in improving care retention for a population at high risk of adverse outcomes. The second paper evaluates the elimination of the federal X-waiver requirement in 2023, which removed a key regulatory barrier to buprenorphine prescribing. Using a difference-in-differences design with Wisconsin Medicaid data, the authors find modest increases in the share of individuals receiving buprenorphine—particularly in rural areas—but no significant change in overall prescription volume. These results suggest that removing administrative barriers alone may be insufficient to meaningfully expand treatment access. The third paper shifts focus to the dispensing side of the treatment market, providing the first causal evidence on the impact of retail pharmacy closures on local buprenorphine supply. Using drug distribution data and a spatial event-study design, the study finds that closures reduce local supply by 19 percent on average, with independent pharmacy closures driving large, persistent declines. The results demonstrate that pharmacy infrastructure constitutes a binding constraint on treatment access, especially in less competitive markets. Finally, the fourth paper examines the role of pharmaceutical manufacturer engagement in shaping buprenorphine prescribing behavior. Linking Open Payments data with national prescription records, the authors show that manufacturer visits increase prescribing among already active clinicians, with stronger effects among generalists and evidence of dose-response relationships. However, promotional efforts appear concentrated among existing prescribers, raising concerns about whether they effectively expand access in underserved populations. Taken together, these papers highlight that expanding MOUD access requires addressing multiple margins simultaneously: improving patient-provider interactions, removing regulatory barriers, sustaining local healthcare infrastructure, and aligning incentives in pharmaceutical markets. The findings underscore the need for coordinated policy approaches that move beyond prescribing constraints to address the full treatment delivery ecosystem.

Policy Area

• Health Policy

Chair

• Joanne Constantin, State University of New York (SUNY) Downstate Health Sciences University

Discussants

• Jessica Erin Pac, University of Wisconsin-Madison

• Magnus J Lofstrom, Public Policy Institute of California

Organizer

• Costas Lambros, Indiana University

Individual Presentations

• Patient-Provider Racial Concordance and Discharges Against Medical Advice Among Patients with Opioid Use Disorder - Presenting Author: Victoria Elizabeth Bethel, University of Georgia

• Prescription Pain: Pharmacy Closures as Persistent, Local Buprenorphine Supply Shocks - Presenting Author: Nicholas Hall, RTI International

• The Impact of Eliminating the X-waiver in Wisconsin - Presenting Author: Taehwan Choi, University of Wisconsin-Madison

• Manufacturer Engagement with Clinicians and Buprenorphine Prescribing: Evidence from Linked Open Payments and National Pharmacy Claims - Presenting Author: Costas Lambros, Indiana University