One of the most important advances in treating opiate addiction has been the development of the drug buprenorphine, also known as Suboxone. Buprenorphine’s effectiveness in stopping cravings and preventing withdrawal symptoms has made it an integral part of medication-assisted treatment.
However, not all areas of the U.S. have equal access to buprenorphine, according to a new analysis by Avalere, a Washington, D.C.-based health care consulting firm.
Avalere’s analysis found that 11 states in the Midwest and Mid-Atlantic, along with the District of Columbia, have significantly lower-than-average rates of providers who prescribe buprenorphine compared to opioid overdose deaths. The states are Illinois, Iowa, Maryland, Michigan, Missouri, North Carolina, New Hampshire, Ohio, Virginia, Wisconsin and West Virginia.
The number of opioid overdose deaths is one way to measure rates of abuse in a state, which can indicate a need for more providers who are able to prescribe addiction treatments, Avalere said.
On average, there are 1.6 opioid overdoses per buprenorphine prescriber nationwide. Another nine states (Arizona, Kentucky, Minnesota, Nevada, Oklahoma, South Carolina, South Dakota, Tennessee and Utah) have lower rates of prescribers per overdose than the national average.
Avalere analyzed drug overdose deaths and contributing causes, using Centers for Disease Control and Prevention (CDC) data.
The researchers used the Substance Abuse and Mental Health Services Administration Treatment Practitioner Locator Database to analyze the number of providers who are certified to prescribe buprenorphine in each state. Avalere analyzed the number of certified providers per reported overdose death and compared each state to the national average to determine which state had a relatively high or low rate of providers, using opioid overdose deaths as a proxy for the severity of the epidemic in each state.
(Some data may have been suppressed by CDC due to small sample size to ensure confidentiality, Avalere noted).
To expand access to MAT, in 2016 Congress passed the Comprehensive Addiction and Recovery Act (CARA), which allows nurse practitioners and physician assistants to seek a federal waiver to prescribe buprenorphine for opioid use disorder.
To prescribe buprenorphine, physicians have to meet certain training requirements, with a limit on the number of patients each physician can prescribe the medication to. CARA allowed nurse practitioners and physician assistants to seek a federal waiver to prescribe buprenorphine after they complete 24 hours of training. Nurse practitioners and physicians can prescribe buprenorphine to 30 patients every year.
Data from the White House shows that 47 percent of counties in the U.S. do not have at least one waived physician who can prescribe buprenorphine and the vast majority of these counties are rural.
“For individuals who are struggling with opioid dependence, buprenorphine can be a critical step in their road to recovery,” said Caroline Pearson, senior vice president at Avalere. “Extending prescribing privileges to nurse practitioners and physician assistants can facilitate access to this evidence-based treatment.”
“Although more providers are now able to prescribe buprenorphine, there appears to be a shortage of prescribers in many states,” said Clara Soh, a director at Avalere. “Evaluating ways to narrow this gap, including bringing state scope-of-practice laws into alignment with federal regulations, would enable policymakers to achieve their goal to expand access.”