Despite changes to expand access to medication treatment for patients with opioid addiction, only 10% of primary care providers in the U.S. are certified to prescribe buprenorphine, a new study found.
While there was an increase in the number of providers who have a waiver to prescribe the opioid-addiction medication over a 10-year period, it’s not enough to address the country’s ongoing opioid epidemic, according to a study in the Annals of Internal Medicine.
If there’s good news it is that that the rate of those primary care providers (PCPs) getting waivers has been fastest in hardest-hit areas, in counties with higher rates of opioid-related overdose deaths. However, despite evidence that the opioid crisis has disproportionately affected socioeconomically disadvantaged rural areas of the country, access to treatment is limited there as the growth of PCPs who can prescribe buprenorphine was much slower, the study found.
“Given the scale of the opioid epidemic in the U.S., it is disappointing that a small percentage of PCPs have waivers. However, it is not just an issue of numbers; it is also an issue of mismatch,” said study co-author Ryan McBain, Ph.D., of the RAND Corporation, in an email to FierceHealthcare.
From 2007 to 2017, the number of providers with waivers increased from 3.8 to 17.3 per 100,000 people, the study found. That growth was relatively incremental, given the increasing number of opioid deaths over the same period, McBain said.
To prescribe buprenorphine, providers must have a waiver from the Drug Enforcement Administration that requires them to complete an eight-hour course and license application. To increase patient access to opioid addiction treatment, the U.S. has increased patient limits to 275 per physician and allowed nurse practitioners and physician assistants to receive waivers. The study found that in 2017, 94.6% of prescribers with waivers were physicians, 4.2% were nurse practitioners and 1.2% were physician assistants.
Allowing nurse practitioners and physician assistants to attain waivers to prescribe buprenorphine should help and it will important to watch the effects of this change in the next several years, McBain said.
Another step is to examine what is driving providers in high-need communities where there have been high numbers of overdose deaths to seek waivers, he said. “For example, to what extent do primary care providers seek waivers because they are seeing overwhelming demand for treatment in their practice? Or are providers in high-need communities being offered more resources for training and support, leading to an uptick? Colloquially, there is evidence pointing to each of these pathways, but more analysis would be helpful.”
The government can do more by making it easier for providers to get waivers or even make it financially rewarding for them, he said. Physicians have also begun discussing the possibility of removing waivers altogether, he added.
There’s evidence that providers who have waivers to prescribe buprenorphine may not be prescribing the medication for a significant number of patients, he said. There are also other obstacles for prescribers.
“Waivers are merely an entry point for permitting providers to offer a service, but there are significant dynamics that shape service provision—stigma experienced by patients, level of time and reimbursement for treatment compared to alternative conditions, fear of attraction of drug users to a clinical practice,” he said.