Geographic disparities affect access to buprenorphine services for opioid use disorder
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Reports-in-brief (Promoting Women in Development (Project))
- Contributor(s):
- United States. Department of Health and Human Services. Office of Inspector General. Office of Evaluation and Inspections. issuing body.
- Publication:
- [Washington, D.C.] : U.S. Department of Health and Human Services, Office of Inspector General, January 2020
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Buprenorphine -- supply & distribution Health Services Accessibility Medically Underserved Area Opiate Substitution Treatment Opioid-Related Disorders -- drug therapy United States United States. Department of Health and Human Services United States. Substance Abuse and Mental Health Services Administration
- Genre(s):
- Technical Report
- Abstract:
- Why OIG Did This Review. Adequate access to treatment is vital in addressing the escalating rates of addiction and mortality related to opioid misuse and abuse. MAT couples medication (such as buprenorphine, methadone, or naltrexone) with counseling and behavioral therapies to treat opioid use disorder. Since 2000, Congress has enacted several measures to increase the availability of MAT, including the creation and expansion of the Buprenorphine Waiver Program. The waiver program allows physicians and certain other qualified providers to prescribe buprenorphine to patients in office settings (e.g., primary care practices, community health centers, treatment centers) rather than limiting this service to specialized opioid treatment programs, which primarily dispense methadone. Despite these efforts, studies still show that only a small percentage of Americans who need treatment actually receive it. How OIG Did This Review OIG used data from SAMHSA to determine the number and nationwide patient capacity of providers who had received waivers to prescribe buprenorphine for MAT as of April 2018. We also used these data to identify U.S. counties with low patient capacity rates. We used three public health data sources to identify counties with high indicators of opioid misuse and abuse (i.e., counties with high need). We then examined the patient capacity rates for these high-need counties and identified those with low-to-no capacity to provide buprenorphine services. What OIG Found. The number of providers who have obtained waivers through the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Buprenorphine Waiver Program has increased significantly since 2002, with close to 47,000 permitted to prescribe the drug in the office setting as part of medication-assisted treatment (MAT) as of April 2018. However, this figure likely overstates the availability of buprenorphine treatment in these settings, as (1) studies show that many waivered providers do not treat up to their approved patient-limit capacity (i.e., up to 30, 100, or 275 patients), and (2) our analysis indicates that access to buprenorphine services through waivered providers is not distributed evenly across the nation. Specifically, 40 percent of counties in the United States did not have a single waivered provider in 2018. Even more concerning, waivered providers were not necessarily found in the areas where access to MAT is most critical. Among the approximately 1,100 counties identified by OIG as having the greatest need for buprenorphine services, 56 percent likely had inadequate capacity to treat patients with buprenorphine in an office setting. What OIG Recommends and How the Agency Responded. OIG recommends that SAMHSA geographically target its efforts to increase the participation of waivered providers in high-need counties. In high-need counties with few or no waivered providers, the best strategy may be for SAMHSA and its grantees to encourage existing local providers to obtain buprenorphine waivers and/or to address overall local shortages of providers in general. In high-need counties that already have higher numbers of waivered providers, it may be more effective for SAMHSA and its grantees to encourage and support existing waivered providers to treat more patients in need of buprenorphine services. SAMHSA concurred with our recommendation.
- Copyright:
- The National Library of Medicine believes this item to be in the public domain. (More information)
- Extent:
- 1 online resource (1 PDF file (31 pages, 5 unnumbered pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918266194506676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918266194506676