Geographic Disparities Affect Access to Buprenorphine Services for Opioid Use Disorder

WHY WE DID THIS STUDY

Adequate access to treatment is vital in addressing the escalating rates of addiction and mortality related to opioid misuse and abuse. Medication-assisted treatment (MAT) couples medication (such as buprenorphine, methadone, or naltrexone) with counseling and behavioral therapies to treat opioid use disorder. Since 2000, Congress has enacted several measures to increase the availability of MAT, including the creation and expansion of the Buprenorphine Waiver Program (waiver program). The waiver program allows physicians and certain other qualified providers to prescribe buprenorphine to patients in office settings rather than limiting this service to specialized opioid treatment programs. Despite these efforts, studies still show that only a small percentage of Americans who need treatment actually receive it.

HOW WE DID THIS STUDY

OIG used data from the Substance Abuse and Mental Health Services Administration (SAMHSA) to determine the number and nation-wide patient capacity of providers who had received waivers to prescribe buprenorphine for MAT as of April 2018. We also used these data to identify U.S. counties with low patient capacity rates. We used three public health data sources to identify counties with high indicators of opioid misuse and abuse (i.e., counties with high need). We then examined the patient capacity rates for these high-need counties and identified those with low to no capacity to provide buprenorphine services.

WHAT WE FOUND

The number of providers who have obtained waivers through SAMHSA's waiver program has increased significantly since 2002, with close to 47,000 permitted to prescribe the drug in the office setting as part of MAT as of April 2018. However, this figure likely overstates the availability of buprenorphine treatment in these settings, as (1) studies show that many waivered providers do not treat up to their approved patient-limit capacity (i.e., up to 30, 100, or 275 patients), and (2) our analysis indicates that access to buprenorphine services through waivered providers is not distributed evenly across the nation. Specifically, 40 percent of counties in the U.S. did not have a single waivered provider in 2018. Even more concerning, waivered providers were not necessarily found in the areas where access to MAT is most critical. Among the approximately 1,100 counties identified by OIG as having the greatest need for buprenorphine services, 56 percent likely had inadequate capacity to treat patients with buprenorphine in an office setting.

WHAT WE RECOMMEND

We recommend that SAMHSA geographically target its efforts to increase the participation of waivered providers in high-need counties. SAMHSA concurred with our recommendation.