Supply of Buprenorphine Waivered Physicians

The Influence of State Policies

Published In: Journal of Substance Abuse Treatment, v. 48, no. 1, Jan. 2015, p. 104-111

Posted on RAND.org on September 29, 2014

by Bradley D. Stein, Adam J Gordon, Andrew W. Dick, Rachel M. Burns, Rosalie Liccardo Pacula, Carrie M. Farmer, Douglas L. Leslie, Mark J. Sorbero

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Research Questions

  1. What impact do state policies have on the number of physicians licensed to prescribe buprenorphine, a drug that can treat addiction to heroin and other opioids?
  2. What county characteristics are associated with the number of physicians approved to prescribe buprenorphine?

Buprenorphine, an effective opioid use disorder treatment, can be prescribed only by buprenorphine-waivered physicians. We calculated the number of buprenorphine-waivered physicians/100,000 county residents using 2008-11 Buprenorphine Waiver Notification System data, and used multivariate regression models to predict number of buprenorphine-waivered physicians/100,000 residents in a county as a function of county characteristics, state policies and efforts to promote buprenorphine use. In 2011, 43% of US counties had no buprenorphine-waivered physicians and 7% had 20 or more waivered physicians. Medicaid funding, opioid overdose deaths, and specific state guidance for office-based buprenorphine use were associated with more buprenorphine-waivered physicians, while encouraging methadone programs to promote buprenorphine use had no impact. Our findings provide important empirical information to individuals seeking to identify effective approaches to increase the number of physicians able to prescribe buprenorphine.

Key Findings

The use of buprenorphine has not been as widespread as expected—it was approved by the FDA in 2002—because few physicians are licensed to prescribe buprenorphine.

In 2011, 43% of U.S. counties had no approved physicians and only 7% had 20 or more approved physicians.

Certain state policies are associated with higher numbers of licensed physicians, including:

  • Medicaid funding for office-based buprenorphine treatment.
  • Detailed guidance on the use of buprenorphine and the distribution of clinical guidelines for buprenorphine treatment.

Counties with higher demand for illicit drugs, as measured by the number of opioid-related overdose deaths and the price of heroin, had greater numbers of licensed physicians.

Encouraging methadone programs to promote the use of buprenorphine had no impact on the number of licensed physicians.

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