Prescribing patterns of buprenorphine waivered physicians

Characteristics and prescribing practices of clinicians recently waivered to prescribe buprenorphine for the treatment of opioid use disorder

“…These findings are concerning, given the escalating opioid crisis in the United States and the significant efforts in recent years to expand use of MAT. Although progress has been made to increase the number of clinicians with a DATA waiver, the prescribing practices identified in our study among this new cohort of clinicians are consistent with prior studies [20][21][22][23]25,28]. A recent study of public sector DATA waived clinicians conducted in New York in 2016, prior to nurse practitioner/physician assistant expansion and the increased 275-patient limit, found that most providers were not prescribing near their authorized patient limits, and despite policies to expand prescribing of buprenorphine there appeared to be ample buprenorphine treatment capacity among their sample of clinicians [28].…”

“…The second model assessed factors associated with prescribing buprenorphine at or near the patient limit in the past month among buprenorphine prescribers. Consistent with prior research, prescribing at or near the patient limit in the past month was defined as prescribing to ≥ 25 patients in the past month for 30-patient waivered clinicians, ≥ 75 patients in the past month for 100-patient waivered clinicians [25] and ≥ 250 patients in the past month for 275-patient waivered clinicians. All clinician characteristics of interest were included in the models, regardless of statistical significance.…”

“…Among the 4225 clinicians in the sample, 56.3% were physicians, 35.3% were nurse practitioners and 8.4% were physician assistants; 54.3% were female; 16.1% were aged [25][26][27][28][29][30][31][32][33][34]26.7% were aged [35][36][37][38][39][40][41][42][43][44]24.7% were aged 45-54, 21.9% were aged 55-64 and 10.7% were aged 65 years or older. Urban practice setting was cited by 44.8% of clinicians, followed by 30.7% in suburban settings and 24.5% in rural settings ( Table 1).…”

“…Studies conducted prior to implementation of these policies identified a number of barriers to prescribing buprenorphine, including willingness to prescribe, low provider confidence in addressing addiction, limited access to addiction experts, lack of institutional or office support, lack of behavioral health services and reimbursement concerns [20][21][22][23][24]. These studies found that many DATAwaived physicians do not actually prescribe buprenorphine, and of these prescribers, the majority do not prescribe to their maximum patient limit [20][21][22][23][24][25].…”

Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County

“…Capacities ranged from 30-430 patients for some group practices, and all providers practiced well under their capacity limit. Prescription Monitoring Program data from Ohio, California, and Maine from January 2010 to April 2015 has also shown that most Buprenorphine waivered providers practice below their waiver capacity [12]. Sacramento County is not fully augmenting the capacity of their current x-waivered clinicians.…”