New data on access to buprenorphine
May 18, 2023
The gold standard of care to treat opioid use disorder is one of three FDA-approved medications: methadone, buprenorphine and naltrexone. Given that methadone may only be obtained from licensed opioid treatment programs and that people must be opioid-abstinent for a week before receiving naltrexone, buprenorphine is often viewed as the most accessible treatment option.
Unfortunately, many people with opioid use disorder still do not have access to buprenorphine. Numerous recent policy changes, including the elimination of the requirement that physicians receive a special waiver before prescribing buprenorphine, have made buprenorphine more accessible. Principle 2 of the Opioid Litigation Principles, Use Evidence to Guide Spending, calls upon states and local jurisdictions to direct money to programs supported by the evidence and to remove policies that may block adoption of such programs.
Two newly published articles explored the current state of buprenorphine prescribing. The articles both looked at two key measures–the number of people starting on the medication (initiation) and the number of people still using it six months after starting (retention).
One article looked at whether changes in New Jersey’s Medicaid program improved buprenorphine initiation and retention. In 2019, New Jersey implemented a new model for buprenorphine care for people in Medicaid, which included removing prior authorization for the medication, implementing new reimbursement codes, establishing Centers of Excellence, and other changes. The researchers found that buprenorphine initiation rates went up by 36% after the implementation of these changes, and that more providers started prescribing buprenorphine. However, the percentage of people retained on buprenorphine at six months did not change. The authors did note that the changes to health care access caused by COVID-19 may have negatively affected retention on the medication.
A second article examined nationwide rates of buprenorphine prescribing and retention from 2016 through October 2022. The authors found an increase in buprenorphine prescribing between January 2016 and September 2018. However, the prescribing rate remained essentially unchanged from September 2018 through October 2022; this plateau began before the arrival of COVID-19. Overall, the rate of retention was unchanged throughout the study period, with roughly 20% of those who started on buprenorphine still using the medication six months later.
The first article highlights the potential for policy and programmatic changes to drive increases in buprenorphine prescribing, and the need for continued work in this area. States should examine their Medicaid policies and determine if there are any barriers impeding access to this life saving meditation. There may be opportunities to use the funds from the opioid litigation to drive improvements in buprenorphine prescribing. In particular, approaches known as “low-threshold buprenorphine”–which offer buprenorphine whenever and wherever a patient is ready–may benefit from additional funding. Offering people who have overdosed on buprenorphine while they are in the emergency department has also been shown to be an effective strategy.
Both articles demonstrate the need for states and communities to focus on medication retention and fund programs designed to help people stay in treatment once they have started. States and communities should explore the provision of additional social supports, such as employment, transportation and housing, to help retain people in treatment. As jurisdictions determine how to spend money from the opioid litigation, they should look for strategies consistent with the Opioid Litigation Principles and invest in areas supported by the evidence.