Growth and Distribution of Buprenorphine-Waivered Providers in the United States, 2007–2017

Background

Expanded access to medication treatment of opioid use disorder is a critical component of the national response to the opioid crisis. Large-scale efforts to increase the number of buprenorphine-waivered prescribers over the past decade have included increasing patient limits to 275 per physician and allowing nurse practitioners and physician assistants to receive buprenorphine waivers. As a result, the number of buprenorphine-waivered clinicians has increased from approximately 17,000 in 2009 to approximately 68,000 in 2019. However, how this growth has varied by community characteristics is unclear.

Objective

To examine county-level growth between 2007 and 2017 in number of buprenorphine-waivered prescribers and variation by county characteristics, including rurality, income, and rate of opioid-related overdose deaths in the past year.

Methods and Findings

Information on all waivered prescribers, including location and patient limit, was obtained from the Substance Abuse and Mental Health Services Administration and the Drug Enforcement Administration; these data were augmented with information from the Pew Foundation and Deerfield Management. Using county population estimates from the 2010 U.S. Census and total physicians per capita, we calculated total number of waivered prescribers per 100,000 persons from 2007 to 2017, overall and by patient limit. Waivered prescribers were assigned to a county on the basis of U.S. Federal Information Processing Standards codes and categorized by discipline as a physician, nurse practitioner, or physician assistant. We used estimates from the Centers for Disease Control and Prevention to identify opioid-related overdose deaths in the past year. Counties were categorized by rurality as metropolitan, large nonmetropolitan (population >20,000), medium nonmetropolitan (population, 2500 to 19,999), or small nonmetropolitan (population <2500) using rural-urban continuum codes from the U.S. Department of Agriculture. We used Census Bureau data to calculate percentage of adults with 4 years of college education, percentage of adults younger than 65 years, percentages of adults of Hispanic and non-Hispanic black race/ethnicity, and per capita income quintiles.