More primary care doctors, specialists prescribing buprenorphine to treat patients for opioid addiction

A coctor writing a prescription
More primary care and specialty physicians have sought waivers and are prescribing buprenorphine in their offices, a new study found. (Getty/18percentgrey)

Given the country’s opioid crisis, multiple laws across the country were changed to allow more physicians to prescribe buprenorphine to help patients addicted to opioids.

Those changes appear to have paid off.

According to a new study in Health Affairs, the number of primary care physicians and specialists prescribing buprenorphine during office visits increased significantly over a nine-year period.

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The study analyzed data from 2006 to 2014 and found a growing involvement of physicians—beyond addiction medicine specialists and psychiatrists who typically treated opioid use disorders—prescribing buprenorphine, a drug that can help patients stay off opioids and reduce overdose deaths.

That is good news since it has the potential to provide better access to care for people with opioid addictions, said the study authors. The country’s ongoing opioid epidemic, which kills an estimated 130 people every day, has left many people struggling with addiction unable to find treatment.

More providers prescribing

The study was based on data from the National Ambulatory Medical Care Survey, a national survey of physicians, and showed that changes to the law to expand access to treatment worked.

The 2000 Drug Addiction Treatment Act allowed office-based providers to obtain a waiver to provide buprenorphine treatment for opioid use disorders which expanded options beyond drug treatment programs and office-based practices of behavioral health professionals. The law was amended in 2006 to raise the patient limit for physicians with those waivers from 30 to 100 people.

Faced with a growing opioid epidemic, the Department of Health and Human Services issued a ruling that took effect in 2016, which further raised the limit from 100 to 275 patients. And the Comprehensive Addiction and Recovery Act of 2016 extended waiver privileges to nurse practitioners and physician assistants.

The study found that between 2006 and 2011, the number of ambulatory visits where doctors prescribed buprenorphine increased 2.3-fold—rates that were similar among visits by addiction medicine specialists and psychiatrists, and primary care physicians and other nonpsychiatry specialists.

Those numbers continued to grow. When researchers looked at data from 2012 to 2014, they found a 6.5-fold increase in buprenorphine prescriptions during office visits from the start of the study, with visits significantly higher among primary care physicians, which included general practice, family medicine and internal medicine practitioners, and other specialists than among psychiatrists.

At the start of the study, primary care physicians accounted for 49.8% of the visits where buprenorphine was prescribed, which increased to 50.8% by the end of the study. The biggest increase in prescribing, however, was among other nonpsychiatry specialists where there was an increase from 8% to 31.4% of the total visits.

Collectively, primary care physicians and other specialists accounted for 86% of the overall increase in visits.

Next steps

The findings suggest that additional policy changes made in 2016, after the study period ended, have the potential to further expand treatment in the coming years, the study authors said. With a shortage of psychiatrists, primary care physicians may play a crucial role in opioid treatment.

The authors said further research is needed to look at which types of specialists are prescribing buprenorphine, whether they are in single or multispecialty practices, and their motivations for obtaining a waiver. Additionally, research may look at why some patients seek treatment from non-mental health specialists and how their outcomes compare to those of patients treated by psychiatrists and primary care physicians.

Fighting the opioid epidemic is a priority for many in Washington, including a group of Democrats in the House of Representatives who are calling on party leadership to step up those efforts. More than 60 Democrats yesterday sent a letter (PDF) to House Speaker Nancy Pelosi, D-Calif., and House Majority Leader Steny Hoyer, D-Md., urging them to make the opioid crisis a top priority in the new Congress.

While Congress passed several bills to increase access to treatment and recovery, they said many states are still seeing an increase in overdose deaths and called for increased resources, creative solutions and more legislative staff to address the ongoing crisis. 

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