New research from the University of Kentucky College of Public Health concludes that the involvement of non-psychiatry physicians in buprenorphine prescribing has the potential to provide better access to care for people with opioid use disorders. Results of the investigation appear in the current issue of Health Affairs. The first author is Dr. Hefei Wen, assistant professor of Health Management and Policy at the UK College of Public Health. Co-authors are Dr. Tyrone Borders, professor of Health Management and Policy and Foundation for a Healthy Kentucky Endowed Chair in Rural Health Policy at the UK College of Public Health; and Dr. Janet R. Cummings, associate professor of the Health Policy and Management at the Emory University Rollins School of Public Health.
Buprenorphine and methadone have both been approved by the U.S. Food and Drug Administration to treat opioid use disorders. Although both have been recognized as essential and cost-effective treatments associated with abstinence and reduced opioid use and opioid-related overdose deaths, the use of methadone for opioid use disorders is restricted to a limited number of specialty opioid treatment programs certified by the Substance Abuse and Mental Health Services Administration (SAMHSA). Buprenorphine, however, can be prescribed by office-based physicians under a waiver created by the Drug Addiction Treatment Act (DATA) of 2000 and its amendments in 2006 and 2016.
Using data from the National Ambulatory Medical Care Survey (NAMCS), the investigators examined differences in total numbers of visits involving a buprenorphine prescription in the periods from 2006 to 2008, 2009 to 2011, and 2012 to 2014. They examined the overall trend, as well as the trend by specialty. They also examined the trend in visits involving buprenorphine prescriptions for qualified opioid use disorder diagnoses.
In the set of nationally representative data, the investigators found that office-based visits involving a buprenorphine prescription increased significantly among primary care and specialist physicians from 2006 to 2014. The findings suggest that a previously reported upward trends in the provision of buprenorphine treatment may have been driven by increased involvement of physicians outside of psychiatry.
Further research is needed to characterize the non-psychiatry specialists who prescribe buprenorphine, including their specialty types (e.g. neurology, oncology, or surgery), practice characteristics (single or multispecialty practice sites), and motivations for obtaining a DATA waiver. Additional research is also needed to understand why some patients with opioid use disorders seek treatment from non-psychiatry specialists, and how their treatment outcomes compare to those of patients treated by psychiatrists and primary care physicians.
Overall, the investigators conclude, “the growing involvement of non-psychiatry physicians in buprenorphine prescribing has the potential to provide better access to care for people with opioid use disorders.”