The article, “Exploring the Association of State Policies and the Trajectories of Buprenorphine Prescriber Patient Caseloads,” has been published in SAj in Volume 44 Issue 1-2.
In this commentary, the authors state that increasing buprenorphine access is critical to facilitating effective opioid use disorder treatment. Buprenorphine prescriber numbers have increased substantially, but most clinicians who start prescribing buprenorphine stop within a year, and most active prescribers treat very few individuals. Little research has examined state policies’ association with the evolution of buprenorphine prescribing clinicians’ patient caseloads.
In the AUTHORS’ OWN WORDS, they relate the importance of their work:
“Many clinicians approved to prescribe buprenorphine historically have not actively prescribed, and many active prescribers have treated very few individuals. One potential way to increase buprenorphine treatment capacity is to identify state policies associated with increasing the percentage of authorized prescribers who actively prescribe it to more patients for longer periods.45 However, our analysis of 3 state policies thought to be associated with buprenorphine prescribing behavior—Medicaid coverage for buprenorphine, prior authorization, and mandated counseling—were not associated with an increase in the percentage of persistent buprenorphine prescribers.”
“Policies that expand the buprenorphine prescriber workforce have been intended to increase treatment access, but these policies may not be sufficient on their own. Because buprenorphine treatment is highly concentrated among a small group of clinicians, it is imperative to increase the size of the clinician workforce who can and will provide care to larger numbers of patients for longer periods of time. Our analysis indicates that several policies that could influence buprenorphine prescribing are not accomplishing this goal. Greater attention should be given to identifying the characteristics of successful high-volume practices (eg, staffing models, referral practices, and care coordination), and policies should focus specifically on creating incentives or supports to replicate these practices.”