Trends in Buprenorphine Prescribing and the Influence of Practice Environments on Clinician Adoption

• In Event: How Practice Environments Shape Physician Behavior and Workforce Decisions

Abstract

Expanding access to buprenorphine for opioid use disorder (OUD) remains a central policy priority in the United States. While prior research has documented substantial clinician-level barriers to prescribing, less is known about how organizational practice environments shape clinicians’ adoption of evidence-based OUD treatment, particularly when clinicians move across group practices. This paper examines whether exposure to high-prescribing peer environments influences clinicians’ likelihood of prescribing buprenorphine following changes in group practice affiliation.

We construct a longitudinal clinician-level panel from 2013–2022 using IQVIA Longitudinal Prescription data linked to clinician taxonomy information from the National Plan and Provider Enumeration System (NPPES) and group practice identifiers. The analytic sample includes 447,187 clinicians who changed practice affiliations during the study period. We exploit within-clinician variation generated by practice transitions and estimate Sun–Abraham event-study models comparing clinicians who moved from low-prescribing origin environments into high-prescribing practices with clinicians who moved but never entered high-prescribing environments. Practice prescribing environments are measured using three leave-one-out indicators based on prior-year peer behavior: practice-level buprenorphine prescribing prevalence, the presence of at least one prescribing peer, and peer prescribing intensity. All models include clinician fixed effects and ZIP code-by-year fixed effects to account for time-invariant clinician characteristics and local policy and treatment market changes.

Nationally, the share of clinicians prescribing buprenorphine increased from 2.4 percent in 2013 to 4.0 percent in 2022, with higher adoption among primary care physicians than specialists or advanced practice providers. Among clinicians moving from low-prescribing environments, between 19.9 and 39.3 percent transitioned into high-prescribing practices depending on the exposure definition. Event-study estimates show a discrete increase in buprenorphine prescribing in the year clinicians join high-prescribing practices, with effects that persist in subsequent years. These findings provide evidence that organizational peer environments shape clinicians’ adoption of buprenorphine prescribing, highlighting the importance of practice-level context in expanding access to medications for opioid use disorder. Policies that support integration of prescribers into treatment-active clinical networks may therefore complement existing training and regulatory reforms aimed at increasing buprenorphine availability.

Author

• Jiaen Wu, Indiana University
  Presenting Author