Panel: Tackling the Opioid Crisis through Buprenorphine Treatment

Saturday, November 9, 2019: 10:15 AM-11:45 AM
I.M Pei Tower: Majestic Level, Vail (Sheraton Denver Downtown)

*Names in bold indicate Presenter

Organizer:  Robin A. Ghertner, Office of the Assistant Secretary for Planning and Evaluation
Panel Chair:  Robin A. Ghertner, Office of the Assistant Secretary for Planning and Evaluation
Discussant:  Bradley D. Stein, RAND Corporation

Opioid-related overdose rates continue to rise, with the CDC reporting a 200% increase over the last decade. As part of efforts to respond to the crisis, federal and state governments have spent considerable resources to increase the availability of buprenorphine for opioid use disorder (OUD). Buprenorphine is one of the three FDA-approved medications to treat OUD, and to prescribe it providers must receive a waiver from the DEA (known as a DATA waiver). Efforts to increase access include expanding the patient limit for providers with DEA waivers, increasing the types of providers who can prescribe, easing the training requirements to receive a waiver, increasing coverage of buprenorphine in health plans (including Medicaid and Medicare), among others. To date, little is known about the impact of these changes on actual prescribing of buprenorphine and other opioids. This panel includes studies that take the first steps at answering these questions.

The first paper examines buprenorphine prescribing trends by whether DATA-waivered providers choose to be listed in the SAMHSA Treatment Locator. The Treatment Locator is a national source for the general public to identify treatment providers in their communities. Providers with waivers can choose to be listed in the locator, though research shows that in 2018 only 57% of them elected to do so. Their prescribing differences is extremely relevant for efforts to expand the availability of buprenorphine.

The second paper looks at ecological relationships between the buprenorphine patient capacity in a county and prescribing of both buprenorphine and other opioids. Providers receive waivers to prescribe to a maximum number of patients concurrently (30, 100, or 250). While DATA waiver policies are intended to affect the crisis by increasing the availability of buprenorphine, the extent to which increases in waivers can affect general opioid prescribing would be a secondary benefit to such policies.

The final paper outlines the extent to which DATA-waivered physicians and psychiatrists practice within hospital-affiliated health systems. The results have implications for continuity of care, as many patients with OUD go to hospitals to treat overdoses or deal with other consequences of their disorders. These results have implications for public health efforts to use hospital interaction to increase access to treatment, particularly for hard to reach and vulnerable populations.

Out-of-Pocket Payments and Naloxone Utilization, 2015-2018
Zeid S. El-Kilani, Jessica White, Meena Vythilingam and Brett Giroir, U.S. Department of Health and Human Services

What Happens to Opioid Prescribing When Buprenorphine Patient Capacity Changes?
Mir Ali, U.S. Department of Health and Human Services and Robin A. Ghertner, U.S. Department of Health & Human Services

Inclusion of Outpatient Buprenorphine Waivered Primary Care Physicians and Psychiatrists in Hospital-Affiliated Health Systems
Brendan Saloner, Johns Hopkins University, Kosali Simon, Indiana University and Lee-Kai Lin, Tunghai University

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