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June 01, 2021
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Small percentage of clinicians write most buprenorphine prescriptions

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Most buprenorphine treatment provided in the U.S. was prescribed by a small proportion of clinicians, an analysis of retail pharmacy records showed.

HHS recently released guidelines that remove the training requirements once necessary for physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and certified nurse midwives to obtain a waiver to prescribe buprenorphine.

Most high-volume buprenorphine prescribers were PCPs, followed by psychiatrists, pain specialists and addiction specialists
Reference: Stein BD, et al. JAMA. 2021;doi:10.1001/jama.2021.4469.

“Policy initiatives and advocacy, such as efforts to remove the training requirements for buprenorphine prescribing, have commonly focused on enlarging the pool of clinicians allowed to prescribe buprenorphine; current legislation under consideration in the U.S. Congress would eliminate these requirements,” Bradley D. Stein, PhD, MD, MPH, the director of the RAND Corporation’s Opioid Policies, Tools and Information Center, and colleagues wrote in JAMA. “However, many trained buprenorphine prescribers are not actively prescribing or are treating few patients, and the overall concentration of patient care among prescribers is not well characterized.”

Bradley D. Stein

Using information collected between January 2017 and December 2018 from the health information technology and clinical research firm IQVIA, Stein and colleagues analyzed data on 50,509 clinicians who prescribed buprenorphine formulations for opioid use disorder at least once for 14,458,729 patient months of care. Most of the clinicians were primary care physicians (43.8%), advanced practice practitioners (20.6%), pain specialists (8%) and psychiatrists (14.7%). Data from physician assistants, nurse practitioners, emergency physicians, addiction specialists and other clinicians were also included.

According to the researchers, across all specialties during the study period, clinicians had active buprenorphine patients for a mean of 10.8 months (median = 7; interquartile range [IQR], 2-23), during which they had a mean of 13.8 patients each month (median = 1.5; IQR, 1-9.8). Addiction specialists had the highest mean active prescribing months (17.7 months; median = 24, IQR, 11-24]), and monthly caseload (32.8 patients; median = 9.6; IQR, 2-45.2).

In addition, the researchers wrote that 50% of all patient months of buprenorphine treatment were prescribed by 4.9% of the studied clinicians. These high-volume prescribers treated a mean of 124.2 patients each month (median = 107; IQR, 86.4-143.3). PCPs (63.6%), psychiatrists (14.3%), pain specialists (8.3%) and addiction specialists (4.4%) represented 90.6% of all high prescribers.

Stein and colleagues wrote that the study results “have important implications for efforts to increase buprenorphine access.” They added that “targeted efforts to support those willing to effectively and safely treat more patients have the potential to increase buprenorphine treatment capacity.”