Buprenorphine prescriber monthly patient caseloads: An examination of 6-year trajectories

Cabreros, Irineo; Griffin, Beth Ann; Saloner, Brendan; Gordon, Adam J.; Kerber, Rose; Stein, Bradley D.

doi:10.1016/j.drugalcdep.2021.109089

Cited by 14 publications

(16 citation statements)

References 40 publications

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“…We also extended prior research by assessing the contribution of patient, prescriber, and geographic factors with discontinuation of buprenorphine in a comprehensive national sample during and before the pandemic. Consistent with existing literature, we find that discontinuation rates were lowest in both 2019 and 2020 among older and commercially insured patients, among those receiving care from specialists in addiction/psychiatry compared with primary care, and in northeastern states known to have strong treatment infrastructure (eg, New York and Massachusetts) 14,18,20. Although 2019 and 2020 were generally similar, one notable difference is that people with treatment covered by Medicaid had relative improvement in discontinuation, while this relatively worsened for people with cash payment.…”

Section: Discussionsupporting

confidence: 83%

“…Consistent with existing literature, we find that discontinuation rates were lowest in both 2019 and 2020 among older and commercially insured patients, among those receiving care from specialists in addiction/psychiatry compared with primary care, and in northeastern states known to have strong treatment infrastructure (eg, New York and Massachusetts). 14,18,20 Although 2019 and 2020 were generally similar, one notable difference is that people with treatment covered by Medicaid had relative improvement in discontinuation, while this relatively worsened for people with cash payment. One possible explanation is that Medicaid enrollees had better continuity of treatment during the pandemic due to emergency provisions that stabilized enrollment and access to care for Medicaid enrollees, 27 whereas those who paid cash may have experienced greater hardship from out-of-pocket cost.…”

Section: Discussionmentioning

confidence: 99%

“…If 2 or more prescribers had the same number of buprenorphine prescriptions for an individual, we chose the earliest buprenorphine prescriber in that month as the primary prescriber. Through the assigned prescriber specialty code, we identified the specialty group, and adopted a parsimonious taxonomy of specialty codes: physician assistant/nurse practitioner (PA/NP), addiction/psychiatry, pain, adult primary care physician (PCP), and other 20. We categorized prescriber buprenorphine volume as low, medium, or high based on the terciles of total buprenorphine prescriptions across all buprenorphine prescribers in the month.…”

Section: Methodsmentioning

confidence: 99%

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Discontinuation of Buprenorphine Treatment for Opioid Use Disorder During the Coronavirus Disease-2019 Pandemic

Saloner¹,

Chang²,

Alexander

et al. 2022

Medical Care

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Background: The coronavirus disease-2019 pandemic has been associated with large increases in opioid-related mortality, yet it is unclear whether specific subpopulations were especially likely to discontinue buprenorphine treatment for opioid use disorder as the pandemic ensued.Objective: The aim was to assess predictors of buprenorphine discontinuation in the early months of the coronavirus disease-2019 pandemic (April-July 2020) compared with a prepandemic period (April-July 2019).Design: In each time period, we estimated a multilevel regression models to assess risk of discontinuation in April-July for people who started buprenorphine in January-February. Models included person-level, prescriber-level, and area-level covariates.Subjects: Individuals age 18 years or older in the all-payer IQVIA Longitudinal Prescription Claims.Measures: The primary outcome was buprenorphine discontinuation (ie, no filled prescriptions during the follow-up periods).

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Discontinuation of Buprenorphine Treatment for Opioid Use Disorder During the Coronavirus Disease-2019 Pandemic

Saloner¹,

Chang²,

Alexander

et al. 2022

Medical Care

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“…It is also possible that there was little change in the overall number of buprenorphine prescribing clinicians or that fewer individuals seeking treatment had commercial insurance coverage to pay for such treatment. Prior research suggests that the monthly patient census of buprenorphine prescribers is relatively stable after the first 2 years, 33 and existing buprenorphine prescribers may have been reluctant to increase the number of individuals they are treating. In such situations, existing patients may be more likely to receive appointments than new patients.…”

Section: Discussionmentioning

confidence: 99%

Buprenorphine Treatment Episodes During the First Year of COVID: a Retrospective Examination of Treatment Initiation and Retention

et al. 2022

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Background During the COVID pandemic, overall buprenorphine treatment appeared to remain relatively stable, despite some studies suggesting a decrease in patients starting buprenorphine. There is a paucity of empirical information regarding patterns of buprenorphine treatment during the pandemic. Objective To better understand the patterns of buprenorphine episodes during the pandemic and how those patterns compared to pre-pandemic patterns. Design Pharmacy claims representing approximately 92% of all prescriptions filled at retail pharmacies in all 50 US states and the District of Columbia. Participants Individuals filling buprenorphine prescriptions indicated for treatment of opioid use disorder. Main Measures The number of active, starting, and ending buprenorphine treatment episodes March 13 to December 1, 2020, and the expected number of such episodes in 2020 based on the growth in treatment episodes from March 13 to December 1, 2019. Key Results The observed number of active buprenorphine episodes in December 2020 was comparable to the expected number, but new treatment episodes starting between March 13 and December 1, 2020, were 17.2% fewer than expected based on the 2019 experience. Similarly, the number of episodes that ended between March 13 and December 1, 2020, was 16.0% fewer than expected. Decreases from expected episode starts and ends occurred throughout the period but were greatest in the 2 months after the declaration of the public health emergency. Conclusions and Relevance Beneath the apparent stability of buprenorphine patient numbers during the pandemic, the flow of individuals receiving buprenorphine treatment changed substantially. Our findings shed light on how policy changes meant to support buprenorphine prescribing influenced prescribing dynamics during that period, suggesting that while policy efforts may have been successful in maintaining existing patients in treatment, that success did not extend to individuals not yet in treatment.

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“…In 2020, 29% of all U.S. counties lacked any practitioner with a DATA waiver and 51% of small or remote rural areas lacked any practitioner with a DATA waiver [ 7 ]. Even when practitioners have a waiver, the vast majority do not prescribe up to their maximum capacity as allowed by law [ 8 , 9 ], suggesting BUP accessibility remains low.…”

Section: Introductionmentioning

confidence: 99%

Perceptions of buprenorphine barriers and efficacy among nurse practitioners and physician assistants

Andraka‐Christou

Page

Schoebel

et al. 2022

Addict Sci Clin Pract

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Background Medications for opioid use disorder (MOUDs), including methadone, buprenorphine, and naltrexone, decrease mortality and morbidity for people with opioid use disorder (OUD). Buprenorphine and methadone have the strongest evidence base among MOUDs. Unlike methadone, buprenorphine may be prescribed in office-based settings in the U.S., including by nurse practitioners (NPs) and physician assistants (PAs) who have a federal waiver and adhere to federal patient limits. Buprenorphine is underutilized nationally, particularly in rural areas, and NPs/PAs could help address this gap. Therefore, we sought to identify perceptions of buprenorphine efficacy and perceptions of prescribing barriers among NPs/PAs. We also sought to compare perceived buprenorphine efficacy and perceived prescribing barriers between waivered and non-waivered NPs/PAs, as well as to compare perceived buprenorphine efficacy to perceived naltrexone and methadone efficacy. Methods We disseminated an online survey to a random national sample of NPs/PAs. We used Mann–Whitney U tests to compare between waivered and non-waivered respondents. We used non-parametric Friedman tests and post-hoc Wilcoxon signed-rank tests to compare perceptions of medication types. Results 240 respondents participated (6.5% response rate). Most respondents agreed buprenorphine is efficacious and believed counseling and peer support should complement buprenorphine. Buprenorphine was generally perceived as more efficacious than both naltrexone and methadone. Perceived buprenorphine efficacy and prescribing barriers differed by waiver status. Non-waivered practitioners were more likely than waivered practitioners to have concerns about buprenorphine affecting patient mix. Among waivered NPs/PAs, key buprenorphine prescribing barriers were insurance prior authorization and detoxification access. Conclusions Our results suggest that different policies should target perceived barriers affecting waivered versus non-waivered NPs/PAs. Concerns about patient mix suggest stigmatization of patients with OUD. NP/PA education is needed about comparative medication efficaciousness, particularly regarding methadone. Even though many buprenorphine treatment patients benefits from counseling and/or peer support groups, NPs/PAs should be informed that such psychosocial treatment methods are not necessary for all buprenorphine patients.

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Buprenorphine prescriber monthly patient caseloads: An examination of 6-year trajectories

Cited by 14 publications

References 40 publications

Discontinuation of Buprenorphine Treatment for Opioid Use Disorder During the Coronavirus Disease-2019 Pandemic

Discontinuation of Buprenorphine Treatment for Opioid Use Disorder During the Coronavirus Disease-2019 Pandemic

Buprenorphine Treatment Episodes During the First Year of COVID: a Retrospective Examination of Treatment Initiation and Retention

Perceptions of buprenorphine barriers and efficacy among nurse practitioners and physician assistants

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