Environmental Munificence and State-Level Variation in Physicians Waivered to Prescribe Buprenorphine for Opioid Dependence

• In Event: 043 - Section on Alcohol, Drugs, and Tobacco Roundtable Session (one-hour).
  In Refereed Roundtable: Table 03. Regulating Drug Access

Abstract

With the FDA’s approval of buprenorphine in 2002, a new treatment option became available to reduce the social and medical costs associated with untreated opioid dependence. Buprenorphine differs from most prescription medications in that physicians must actively seek a “waiver” in order to prescribe it. This system of “waivering” raises the question of whether states vary in their supply of buprenorphine physicians, defined as the number of “waivered” physicians per 1 million residents. This study integrates data extracted from the DEA’s database of waivered physicians with state-level indicators of environmental munificence, opioid-specific demand characteristics, and macro environmental factors. As of December 2013, the average state had about 83 buprenorphine physicians per 1 million residents. There were large regional differences between states in the Northeast relative to states in the Midwest, South, and West, which persisted in a multivariate ordinary least squares (OLS) regression model. The final model provided strongest support for associations between indicators of environmental munificence and buprenorphine physician supply. Specifically, the percentage of residents covered by Medicaid, population-adjusted availability of opioid treatment programs, and availability of substance abuse treatment facilities were positively associated with buprenorphine physician supply. In addition, buprenorphine physician supply was positively correlated with states’ rates of overdose deaths, suggesting that physicians may seek the waiver in response to the magnitude of the opioid problem in their state. Taken together, these findings point to ongoing disparities in the availability of health care in the US, which can be partly attributed to specific state characteristics.

Author

• Hannah K. Knudsen, University of Kentucky