Many physicians who prescribe buprenorphine are prescribing below the patient limits historically allowed under U.S. law.

Cover: Physician Capacity to Treat Opioid Use Disorder with Buprenorphine-Assisted Treatment

Physician Capacity to Treat Opioid Use Disorder with Buprenorphine-Assisted Treatment

Published in: JAMA, v. 316, no. 11, Sep. 2016, p. 1211-1212

Posted on RAND.org on September 28, 2016

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

Research Question

  1. Are limits on the number of patients that an approved physician can treat with buprenorphine (for treating opioid disorder) a barrier to treatment?

Buprenorphine, a medication effective in treating individuals with opioid use disorders, can be prescribed in the United States by addiction specialists or by physicians who complete an 8-hour course and obtain a US Drug Enforcement Administration waiver. Waivered prescribers have been restricted to treating up to 30 patients with an opioid use disorder concurrently; after a year, physicians could request that the limit be increased to 100 patients. Policy makers have prioritized increasing capacity to provide buprenorphine to fight the opioid epidemic but lack adequate information about how to do so effectively. Patient censuses of buprenorphine prescribers were examined to provide information on whether patient limits have been a barrier to buprenorphine treatment.

Key Findings

  • Current limits (which allow 30 patients to be treated concurrently, with the possibility of an increase to 100 after one year of practice) do not appear to be a barrier to patient access to buprenorphine treatment.
  • Monthly patient censuses for 3234 buprenorphine prescribers with 245,016 patients showed that most approved physicians were treating numbers of patients well below the current limits: More than 20% treated 3 or fewer patients, and fewer than 10% treated more than 75 patients.
  • Novice prescribers cited insufficient access to more experienced prescribers and insufficient access to substance abuse counseling for patients as barriers to treating more patients.

Recommendations

  • Such barriers might be addressed by web-based or telecounseling for patients and by programs providing mentoring and telephone consultation from more experienced prescribers.
  • Strategies to help current prescribers treat more patients safely and effectively could complement policy initiatives designed to increase access to treatment by increasing patient limits and number of waivered prescribers.
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