SAMHSA Is Missing Opportunities To Better Monitor Access to Medication Assisted Treatment Through the Buprenorphine Waiver Program

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WHY WE DID THIS STUDY

Combating the opioid crisis by expanding treatment services is a key priority for SAMHSA. The Buprenorphine Waiver Program-one of SAMHSA's primary initiatives to address this priority-currently authorizes 90,000 providers to provide medication-assisted treatment (MAT) to patients with opioid use disorder. However, SAMHSA does not know how many total patients actually receive MAT through the program because it does not collect this information from all enrolled providers.

HOW WE DID THIS STUDY

SAMHSA requires a subset of 6,000 waivered providers-those authorized to treat the maximum number of patients allowed by law (i.e., 275)-to annually report the number of patients to whom they provided MAT. The primary purpose of this annual reporting requirement is to allow SAMHSA to monitor providers' compliance with additional requirements in place for providers authorized at this 275-patient limit. However, because these data constitute the only information that SAMHSA currently collects from waivered providers, OIG used the data to examine the waiver program's success in a broader goal-expanding access to treatment. Although they represent only a small percentage of waivered providers, the 6,000 providers approved at the maximum patient level are important for access to MAT, because they are permitted to treat a much greater patient load and often specialize in addiction treatment. We examined how many providers submitted the required annual report during 2019. For the latest month with complete data (June 2019), we examined the number of MAT patients whom each provider reported treating and whether providers located in counties with a high need for MAT services treated more patients than providers located elsewhere.

WHAT WE FOUND

In 2019, 77 percent of providers who were waivered at the 275-patient level did not submit required data to SAMHSA regarding the number of MAT patients they served. SAMHSA says that it has opted to exercise its discretion and not enforce the reporting requirements because the opioid crisis is a public health emergency and it does not want to disrupt patients' access to MAT services. According to the limited data available, providers treated an average of 116 MAT patients-far below the 275-patient limit. Additionally, providers located in high-need counties reported treating more MAT patients on average than providers located elsewhere-127 versus 107 patients, respectively.

WHAT WE RECOMMEND

Without valid data about waivered providers' patient loads and prescribing practices, SAMHSA lacks consistent, reliable information with which to monitor patient access and identify unmet needs for MAT services. OIG recommends that SAMHSA develop methods to better measure access to MAT via office-based providers. As policymakers consider changes to the waiver program, it will be critical to have valid data on the number of patients accessing MAT. With improved data, SAMHSA could better do the following: understand providers' MAT prescribing practices; monitor trends in the number of MAT patients being served; identify geographic areas where patients with opioid use disorder remain underserved; and target where to deploy its training and technical assistance resources. SAMHSA concurred with this recommendation.