National trends in buprenorphine prescribing before and during the COVID-19 pandemic

Ali, Mir M.; Creedon, Timothy B.; Jacobus-Kantor, Laura; Sherry, Tisamarie B.

doi:10.1016/j.jsat.2022.108923

Cited by 12 publications

(14 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent policies have reduced or removed DATA waiver requirements to prescribe buprenorphine, including the June 2021 elimination of training requirements to obtain a waiver to treat 30 patients simultaneously. This resulted in a 16% increase in waivered clinicians but not an acceleration in buprenorphine uptake . With the removal of the waiver entirely in the 2023 Consolidated Appropriations Act, this study brings into question the assumption that eliminating the DATA waiver will lead to substantial increases in buprenorphine access.…”

Section: Discussionmentioning

confidence: 90%

“…However, the findings from CAPLA were consistent with those from similarly rigorous multicenter randomized trials with intensive follow-up, which have not reported a benefit of any add-on strategy to PVI in patients with persistent AF. 2,3 In fact, contrary to the assertion by Mohanty and colleagues, a meta-analysis that included 17 studies (14 observational, 3 randomized) in patients with paroxysmal and persistent AF did not confirm an incremental benefit with PWI. 4 Indeed, a small randomized study of 110 patients with persistent AF using the cryoballoon showed no significant reduction in all atrial arrhythmias with addition of PWI to PVI alone.…”

Section: Comment and Responsementioning

confidence: 85%

“…However, the assumed success rates (60% vs 75%) were reported from studies enrolling patients with or without antiarrhythmic medications. 2,3 We believe that this study 1 should have used the success rate of 41% (PVI only) vs 50.6% (PVI and PWI) in patients without antiarrhythmic medications. 2,3 This effect size would have been in agreement with the primary end point of this study 1 and would have required a substantially larger sample size (422 patients per group) to provide adequate power.…”

Section: Comment and Responsementioning

confidence: 97%

“…This resulted in a 16% increase in waivered clinicians but not an acceleration in buprenorphine uptake. 2 With the removal of the waiver entirely in the 2023 Consolidated Appropriations Act, 3 this study brings into question the assumption that eliminating the DATA waiver will lead to substantial increases in buprenorphine access. While removal of this barrier may make it easier for clinicians to begin prescribing, additional investments may be needed to build and support clinicians treating OUD.…”

Section: Supplemental Contentmentioning

confidence: 99%

“…The Drug Addiction Treatment Act (DATA) of 2000 created a pathway for clinicians to obtain waivers (“DATA waivers”) to simultaneously treat up to 30, 100, or 275 patients with OUD outside of an opioid treatment program, provided the clinicians met certification and training requirements. Policies in 2021 reduced waiver requirements and in 2023 removed waiver requirements, leading to expectations of increased OUD treatment. It is important to understand historical clinician prescribing patterns prior to these policy changes to track the specific effects going forward.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit

Luo

Erikson

2023

JAMA

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 90%

Section: Comment and Responsementioning

confidence: 85%

Section: Comment and Responsementioning

confidence: 97%

Section: Supplemental Contentmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit

Luo

Erikson

2023

JAMA

View full text Add to dashboard Cite

show abstract

Buprenorphine Prescribing and Challenges Faced Among National Health Service Corps Clinicians

Rowan,

Shah,

Binns

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceThe National Health Service Corps (NHSC) Loan Repayment Program (LRP) expansion in fiscal year (FY) 2019 intended to improve access to medication for opioid use disorder (MOUD) by adding more clinicians who could prescribe buprenorphine. However, some clinicians still face barriers to prescribing, which may vary between rural and nonrural areas.ObjectiveTo examine the growth in buprenorphine prescribing by NHSC clinicians for Medicaid beneficiaries during the NHSC LRP expansion and describe the challenges to prescribing that persist in rural and nonrural areas.Design, Setting, and ParticipantsThis cross-sectional study analyzed preexpansion and postexpansion Medicaid claims data to evaluate the percentage of prescriptions of buprenorphine filled during FY 2017 through 2021. This study also analyzed challenges and barriers to prescribing MOUD between rural and urban areas, using results from annual surveys conducted with NHSC clinicians and sites from FY 2019 through FY 2021.ExposurePrescribing of buprenorphine by NHSC clinicians.Main Outcomes and MeasuresThe main outcomes were the percentage and number of Medicaid beneficiaries with opioid use disorder (OUD) who filled a prescription for buprenorphine before and after the LRP expansion and the challenges NHSC clinicians and sites faced in providing substance use disorder and OUD services. Survey results were analyzed using descriptive statistics.ResultsDuring FYs 2017 through 2021, 7828 NHSC clinicians prescribed buprenorphine (standard LRP: mean [SD] age, 38.1 [8.4] years and 4807 females [78.9%]; expansion LRPs: mean [SD] age, 39.4 [8.1] years and 1307 females [75.0%]). A total of 3297 NHSC clinicians and 4732 NHSC sites responded to at least 1 survey question to the 3 surveys. The overall percentage of Medicaid beneficiaries with OUD who filled a prescription for buprenorphine during the first 2.5 years post expansion increased significantly from 18.9% before to 43.7% after expansion (an increase of 123 422 beneficiaries; P &lt; .001). The percentage more than doubled among beneficiaries living in areas with a high Social Vulnerability Index score (from 17.0% to 36.7%; an increase of 31 964) and among beneficiaries living in rural areas (from 20.8% to 55.7%; an increase of 45 523). However, 773 of 2140 clinicians (36.1%; 95% CI, 33.6%-38.6%) reported a lack of mental health services to complement medication for OUD treatment, and 290 of 1032 clinicians (28.1%; 95% CI, 24.7%-31.7%) reported that they did not prescribe buprenorphine due to a lack of supervision, mentorship, or peer consultation.Conclusions and RelevanceThese findings suggest that although the X-waiver requirement has been removed and Substance Abuse and Mental Health Services Administration guidelines encourage all eligible clinicians to screen and offer patients with OUD buprenorphine, as permissible by state law, more trained health care workers and improved care coordination for counseling and referral services are needed to support comprehensive OUD treatment.

show abstract

Access to Medications for Opioid Use Disorder During COVID-19: Retrospective Study of Commercially Insured Patients from 2019–2022

Rajagopal,

Westra,

Raji

et al. 2024

American Journal of Preventive Medicine

View full text Add to dashboard Cite

National trends in buprenorphine prescribing before and during the COVID-19 pandemic

Cited by 12 publications

References 13 publications

Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit

Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit

Buprenorphine Prescribing and Challenges Faced Among National Health Service Corps Clinicians

Access to Medications for Opioid Use Disorder During COVID-19: Retrospective Study of Commercially Insured Patients from 2019–2022

Contact Info

Product

Resources

About