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Opioid Treatment Access Stalls Despite Buprenorphine Prescribing Flexibility

Buprenorphine initiation and retention rates stood still from 2016 to 2022, even amid policy changes to opioid treatment access and buprenorphine prescribing practices.

Although buprenorphine prescribing regulations were relaxed to increase opioid treatment access, medication rates remained unchanged between 2016 and 2022; researchers suggested that additional barriers beyond buprenorphine availability may be at play in preventing care access.

Almost all states in the US have regulations in place for opioid treatment centers, which are recognized for delivering medication-assisted treatment (MAT). However, these regulations often lack evidence-based support and ultimately limit patient access to care.

Experts have previously noted that the limited number of providers authorized to prescribe buprenorphine is a significant barrier to patient care access, suggesting that current prescribing regulations may hinder access to MAT.

The research letter published in JAMA Network used national prescription data to examine buprenorphine initiation trends and the retention rate of patients on the medication for a minimum of six months from 2016 to 2022.

Within this timeline, two notable modifications were made to buprenorphine prescribing rules. In 2020, regulations were relaxed to allow patients to receive buprenorphine prescriptions through telemedicine, eliminating the need for in-person visits to increase opioid treatment access.

Following that, in the spring of 2021, prescribers were no longer mandated to undertake an eight-hour federal educational program to be eligible to prescribe buprenorphine.

The study findings revealed that the monthly buprenorphine initiation rate increased from 12.5 to 15.9 per 100,000 patients between January 2016 and September 2018. However, the rate remained flat between October 2018 and October 2022, when the policy changes took effect.

From March 2020 to December 2020, the median monthly buprenorphine initiation rate was slightly lower than in previous periods, but no significant changes were observed.

The study also revealed that only 22 percent of individuals who began a buprenorphine treatment regimen continued to refill their prescriptions for at least six months. The researchers noted that longer periods of buprenorphine treatment are associated with a reduced risk of opioid overdose death.

“The fact that buprenorphine initiation and retention did not rise after these efforts were implemented suggests that these policy changes were insufficient to address the barriers to prescribing enough to meet the rising need for this medication,”  Kao-Ping Chua, MD, PhD,  lead study author and an assistant professor of pediatrics in the Susan B. Meister Child Health and Evaluation Research Center at the U-M Medical School, said in a press release.

This year, the federal government has removed a significant obstacle for prescribers by allowing any physician, nurse practitioner, or clinician who can prescribe other controlled substances to prescribe buprenorphine without special approval.

However, there are new challenges on the horizon, as the US Drug Enforcement Agency has proposed a rule that could create additional barriers for prescribers. Specifically, the proposed rule would partially reverse the pandemic policy of allowing telehealth visits for buprenorphine prescriptions without in-person consultations.

In addition, the federal government is now mandating all clinicians to complete eight hours of addiction treatment training when renewing their controlled substance licenses.

“I worry that this requirement, which hasn’t been well publicized, could result in some prescribers no longer having a controlled substance license entirely, decreasing the number of eligible prescribers,” said Amy Bohnert, PhD, the senior author of the new paper and a professor in the U-M Department of Anesthesiology.

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