Association for Public Policy Analysis & Management

Background and objectives: The US Department of Health and Human Services declared the nation’s opioid crisis to be a public health emergency in 2017 (Collins, Koroshetz, & Volkow, 2018). Buprenorphine, naltrexone, and methadone are FDA-approved medications for the treatment of opioid use disorder (OUD). Compared with methadone and naltrexone, buprenorphine has relatively high patient retention and sustained recovery as well as low addiction liability and minimum overdose risk (Johnson et al., 2000). According to the 2000 Drug Addiction Treatment Act and the 2006 Office of National Drug Control Policy, buprenorphine may only be prescribed by practitioners who have received a waiver from Substance Abuse & Mental Health Services Administration (SAMHSA) following special education. In order to increase the public awareness of access to buprenorphine, SAMHSA maintains an online list of certified practitioners who have opted to be listed publicly (the SAMHSA’s Buprenorphine Treatment Locator).

Our study examines whether publicly-listed providers prescribed more buprenorphine to Medicare patients than non-listed providers as well as interacted more often with buprenorphine manufacturers. Additionally, we identify listing status by providers specialty (non-addiction specialist vs. non-psychiatrists) and other demographic information.

Data and methods: Data come from the SAMHSA Treatment Locator website for 2019 and a list of all DATA 2000 buprenorphine-waived practitioners for all years available from a Freedom of Information Act request directed at SAMHSA data. The publicly listed buprenorphine-waived physicians were linked to the Centers for Medicare & Medicaid Services National Plan and Provider Enumeration System, Medicare Part D Prescriber Public Use File 2014-2016, and Open Payments data 2014-2016 using physician name and ZIP code following previous literature.

Results: Prescribers who opted to be listed tend to prescribe Suboxone more than their non-listed prescribers for MOUD (230 daily doses per year, p<0.001). The differences in means for other buprenorphine drugs for the listed prescribers and non-listed prescribers, are positive but trivial. Interestingly, these listed prescribers tend to prescribe Vivitrol (the once-per-month depot injection brand name version of naltrexone) less than their peers (4.1 daily does per year, p<0.001). The listed physicians also tend to have more interactions with buprenorphine manufacturers via drug promotional activities than their peers. Particularly, listing on the SAMHSA’s Buprenorphine Practitioner Locator was associated with additional $40 detailing gifts/payments per year received by physicians (p<0.05).

Conclusions:

Physicians, who were publicly listed on the SAMHSA website, tend to prescribe more buprenorphine (Suboxone) to Medicare Part D patients and interact more often with buprenorphine sales representatives.