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Many physicians not offering new appointments, rapid buprenorphine access to active heroin users

A recent study found that many buprenorphine prescribers did not offer new appointments or rapid buprenorphine access to those who reported active heroin use, especially those who were covered by Medicaid.

“Patients must be in active opioid withdrawal to initiate buprenorphine treatment safely, which makes the timing of introduction critical,” Tamara Beetham, of the Harvard T.H. Chan School of Public Health, and colleagues wrote. “Outcomes are better when introduction is offered as soon as possible, but many clinicians have specific requirements for patients to meet before offering them buprenorphine, such as active engagement in counseling, which may result in delays.”

To evaluate real-world access to buprenorphine treatment in patients who reported current heroin use, two research assistants called clinicians from July to November 2018 posing as a female patient aged 30 years who reported heroin use and was interested in initiating buprenorphine-naloxone treatment. Two scripts were used: one in which the patient was covered by Medicaid, and another in which the patient was uninsured but willing to pay cash. Clinicians were called twice, once using each script, at least 4 weeks apart during regular business hours.

Researchers included clinicians listed on the public Buprenorphine Practitioner Locator Web site who were located in one of the five states (Massachusetts, Ohio, Maryland, West Virginia, New Hampshire) with the highest opioid-related overdose mortality rates in 2016 or Washington, D,C., which had a similarly high rate.

A total of 1,092 contacts were made to 546 clinicians, with 849 calls reaching schedulers (78% response rate). New appointments were offered to 54% of Medicaid contacts and 62% of uninsured contacts who offered to pay cash. Physicians offered appointments during which buprenorphine would possibly be administered to 27% of Medicaid contacts and 41% of uninsured self-pay contacts.

After scheduling, the median wait time for the first appointment was 6 days for Medicaid contacts and 5 days for uninsured self-pay contacts. For a first appointment with the possibility of buprenorphine initiation, the median wait time was 8 days for Medicaid contacts and 7 days for uninsured self-pay contacts.

“To better inform policy, future efforts should evaluate state policies regarding reimbursement for buprenorphine therapy as well as existing access to treatment,” Pooja A. Lagisetty, MD, MSc, and Amy Bohnert, PhD, of the University of Michigan School of Medicine, the Veterans Affairs Ann Arbor Healthcare System, and the Institute of Health Policy and Innovation, wrote in an editorial accompanying the study. “In the interim, however, the findings demonstrate that many existing buprenorphine providers are willing to provide timely care to new patients. The more pressing challenge may be to engage and connect patients with these prescribers.” – by Erin Michael

Disclosures: Beetham, Lagisetty and Bohnert report no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.