Federal Policy and Adoption of the 275-Patient Buprenorphine Treatment Waiver: A State-Level Longitudinal Analysis

• In Event: 2151 - Section on Alcohol, Drugs, and Tobacco Roundtable
  In Refereed Roundtable 60min: 2. Critical Analyses of Responses to Drug Use

Abstract

Increasing access to buprenorphine treatment is critically important to efforts to address 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 and estimates associations between the supply of 275-patient waivers and state-level measures of region, the Medicaid expansion, unmet treatment need, and the pre-existing supply of 100-patient waivered physicians. Monthly state-level counts of physicians holding the 275-patient waiver, per 100,000 residents, were calculated over 21 months using the Drug Enforcement Agency data. State characteristics were obtained from publicly available sources. During the 21-month period, the number of 275-patient waivers increased from 153 to 4,009 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) per 100,000 residents in May 2018 (t=-9.84, df=50, p<.001). The final mixed effects regression model indicated that region and the pre-existing supply of 100-patient waivered physicians were correlated with the rate of growth in 275-patient waivers. 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.

Authors

• Hannah K. Knudsen, University of Kentucky

• Lewei (Allison) Lin, University of Michigan

• Michelle R. Lofwall, University of Kentucky