Association for Public Policy Analysis & Management

Background: The federal government has simultaneously worked to increase access to medication assisted treatment (MAT) for opioid use disorder (OUD) and decrease general opioid prescribing. Several policies over the past few years have targeted increasing the number of patients with OUD that can receive buprenorphine treatment. These include increasing the patient limits of providers with a DATA waiver to prescribe buprenorphine (up from 100 to 250), and increasing the types of providers that can get a waiver patient (including nurse practitioners and physician assistants). While research has demonstrated an increase in the number of providers with DATA waivers, and that this increase has led to greater buprenorphine prescribing, less is known about how waivers relate to general opioid prescribing. This study examines the relationship between changes in total patient capacity for waivered providers by county and rates of opioid and buprenorphine prescribing.

Data and Methods: Administrative records on the patient limit for all waivered providers from the Substance Abuse and Mental Health Administration (SAMHSA) were aggregated to the county level and merged together with indicators of opioid prescribing from 9 state prescription drug monitoring programs, for the years 2016 and 2018. County fixed-effect linear regression models were run, accounting for a number of economic and demographic state and county-level indicators, to identify the changes within counties in prescribing associated with patient capacity changes.

Results: Counties with increases in patient capacity saw decreases in opioid prescribing and increases in buprenorphine prescribing, with the relationship being strongest in non-metropolitan counties and when providers opted to be publicly listed in the SAMHSA treatment locator tool.

Conclusion: Results suggest that changes in the availability of buprenorphine has a secondary effect of reducing overall opioid prescribing rate, a positive sign for policymakers interested in simultaneously increasing access to MAT and reducing overall opioid prescribing.