Association of Selected State Policies and Requirements for Buprenorphine Treatment With Per Capita Months of Treatment
JAMA Health Forum (05/26/23) Vol. 4, No. 5 Stein, Bradley D.; Saloner, Brendan K.; Golan, Olivia K.; et al.
An analysis of U.S. pharmacy claims linked increased buprenorphine use over time with state training policies outside of initial educational requirements for buprenorphine dispensation. The researchers compared six state-level policies corresponding to the rate of individuals prescribed buprenorphine per 1,000 county residents from Jan. 1, 2006, through Dec. 31, 2018. They examined state implementation of policies requiring additional training for prescribers beyond waiver training, continuing medical education (CME) on substance misuse and addiction, Medicaid coverage of buprenorphine, Medicaid expansion, obligatory prescription drug monitoring programs (PDMPs) and pain management clinic regulations. The average number of months of buprenorphine treatment per 1,000 persons nationally rose from 1.47 in 2006 to 22.80 in 2018. "We found that required education of buprenorphine prescribers beyond the waiver requirement was associated with significant increases in the number of months of buprenorphine treatment per capita in the year following policy implementation," the authors wrote. They also associated the requirement of CME for physician licensure related to substance misuse and addiction with substantially higher buprenorphine use in each of the five years following implementation, from 7.01 treatment months per 1,000 residents in the first year to 11.43 treatment months in the fifth year. Medicaid expansion, Medicaid buprenorphine coverage, pain management clinic rules and required PDMPs did not correlate with increased treatment months per 1,000 residents. "CME and other requirements can be directly modified by state medical boards, are a relatively low burden for clinicians to complete, and can be targeted to groups of nonprescribing clinicians who serve patients who might benefit from buprenorphine," the authors concluded.
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