September 20, 2016
Many American physicians who prescribe buprenorphine are prescribing substantially below the patient limits historically allowed under the law for physicians providing office-based medication-assisted treatment to patients addicted to opioids, according to a new RAND Corporation study.
Published in the Sept. 20 issue of the Journal of the American Medical Association, the study shows that more than 20 percent of actively prescribing waivered physicians treated three or fewer patients and fewer than 10 percent treated more than 75 patients.
The law at the time of the study allowed waivered physicians (those who had received a waiver allowing them to use buprenorphine to treat individuals addicted to opioids) to treat up to 30 patients at the same time. After one year, physicians could request to have their limit increased to 100 patients.
The researchers used prescribing data from approximately 90 percent of prescriptions filled at retail pharmacies from January 2010 through December 2013 from the seven states with the most buprenorphine-waivered physicians. Those states are California, Florida, Massachusetts, Michigan, New York, Pennsylvania and Texas. They identified 3,234 buprenorphine prescribers treating 245,016 patients with a new prescription of buprenorphine. In addition to finding many physicians treating relatively few patients, the researchers found a median treatment duration of 53 days, a treatment period briefer than is likely to produce successful outcomes for many patients.
“Novice prescribers cite insufficient access to more-experienced prescribers and insufficient access to substance abuse counseling for patients as barriers to treating more patients,” said Dr. Bradley Stein, the study's senior author, a senior physician scientist at RAND, a nonprofit research organization, and associate professor of psychiatry at University of Pittsburgh School of Medicine. “These barriers might be addressed by programs providing mentoring and telephone consultation from more-experienced prescribers. Web-based or tele-counseling for patients also may be helpful in communities where patients have difficult accessing trained counselors.”
RAND researchers suggest that strategies to help current prescribers treat more patients safely and effectively could complement recent policy initiatives designed to increase access to treatment by increasing patient limits and number of waivered prescribers.
The study's findings are limited in that the researchers were unable to determine if physicians were waivered to treat 30 patients or to treat 100 patients. There also was no information in the data about the nature or severity of the patient's disorder, and researchers could not exclude that buprenorphine was prescribed off-label for pain.
Support for the study was provided by the National Institute on Drug Abuse. Other authors of the study are Andrew W. Dick, Rosalie L. Pacula, Mark Sorbero and Rachel M. Burns, all of RAND, and Dr. Adam J. Gordon of University of Pittsburgh School of Medicine.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.