Despite relaxed buprenorphine prescribing regulations, access to opioid treatment has remained unchanged in the US between 2016 and 2022, according to a study in JAMA Network. The study found that longer treatment periods are associated with a reduced risk of opioid overdose death, and only 22% of those who began a buprenorphine treatment regimen continued to refill their prescriptions for at least six months. Researchers suggested that additional barriers beyond buprenorphine availability may be at play in preventing care access.
The opioid epidemic has been a significant public health crisis in the United States, with a high number of individuals experiencing opioid use disorders (OUDs) and opioid-related overdose deaths. Medication-assisted treatment (MAT), which involves the use of medications such as buprenorphine, methadone, and naltrexone, is effective in treating OUDs. However, access to MAT has been limited due to various barriers, including regulatory restrictions on buprenorphine prescribing.
In recent years, there have been efforts to relax buprenorphine prescribing regulations to increase access to opioid treatment. Despite these efforts, the impact on opioid treatment access has been limited. This article discusses the findings of a study that examined the impact of relaxed buprenorphine prescribing regulations on opioid treatment access in the US.
Background
Opioid treatment centers in the US are regulated by state regulations that often lack evidence-based support, limiting patient access to care. The limited number of providers authorized to prescribe buprenorphine has been identified as a significant barrier to patient care access. The current buprenorphine prescribing regulations may hinder access to MAT.
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.
Study Methodology
The study 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. The study aimed to evaluate the impact of relaxed buprenorphine prescribing regulations on opioid treatment access.
Results
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.
Discussion
The limited impact of relaxed buprenorphine prescribing regulations on opioid treatment access indicates that additional barriers beyond buprenorphine availability may be at play in preventing access to care. The study findings suggest that the policy changes were insufficient to address the barriers to prescribing enough to meet the rising need for this medication.
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 that all clinicians complete eight hours of addiction treatment training when renewing their controlled substance licenses. This requirement could result in some prescribers no longer having a controlled substance license entirely, decreasing the number of eligible prescribers.
