Adding Requirements to Buprenorphine Prescribers Increased Prescriptions?

Recently, JAMA Health Forum published an investigation focused on understanding the association between requirements for buprenorphine prescribers beyond those required to obtain a waiver and the rate of buprenorphine dispensing. The report found that based on county-level pharmacy claims data, educational requirements for buprenorphine prescribers beyond the waiver requirements were associated with an increase in dispensing of buprenorphine, as was continuing medical education related to substance misuse and addiction.

The study evaluated the association of six selected state policies with the rate of individuals receiving buprenorphine per every 1000 county residents. Authors used 2006 to 2018 United States retail pharmacy claims data for individuals who received buprenorphine formulations indicated for treating opioid use disorder.

The mean number of months of buprenorphine treatment per 1000 persons nationwide increased from 1.47 in 2006 to 22.80 in 2018. However, requiring that buprenorphine prescribers receive additional education beyond the federal X-waiver requirements resulted in a significant increase in the number of months of buprenorphine treatment in the five years following the implementation of the requirement (8.51 in year 1 to 14.43 in year 5). The study also found that many clinicians stop prescribing buprenorphine within one year of their first dispensed prescription and that most active prescribers treat few individuals. This means that growth in the number of buprenorphine prescribers has not resulted in an increase in buprenorphine subscriptions.

Requiring continuing medical education related to substance misuse or addiction for physician licensure was also associated with significant increase (from 7.01 months in the first year to 11.43 months in the fifth year). The study further noted that “even if CMEs do not increase the local pool of buprenorphine prescribers, they may increase awareness of buprenorphine treatment efficacy, leading clinicians to support patients’ ongoing engagement in treatment and motivating nonprescribers encountering a patient with OUD to make an appropriate referral.”

While education made a marked difference in buprenorphine prescriptions, the study also found that prescription drug monitoring programs, pain management clinic laws, and Medicaid policies had no association with buprenorphine dispensing.

The study authors concluded that “meaningful changes in access to buprenorphine may be achieved through greater attention to professional education and clinician knowledge.” They went on to cite that the findings “suggest requiring education for buprenorphine prescribers and training in substance use disorder treatment for all controlled substance prescribers as an actionable proposal for increasing buprenorphine use, ultimately serving more patients” and that while “no single policy lever can ensure adequate buprenorphine supply…policy maker attention to the benefits of enhancing clinician education and knowledge may help to expand buprenorphine access.”