Clinicians Prescribing Buprenorphine Far Below Limits of Waivers

Research published on JAMA Network Open on Monday shows that about half of clinicians who are waivered to prescribe buprenorphine for the treatment of opioid use disorder have actually done so, and that a majority of clinicians are prescribing the medication for a number of patients that is well below the limit for which they are waivered.

The study, conducted by Pew Charitable Trusts, Deerfield Management Co. and Rand Corp., reviewed data from April 2017 to January 2019. Among the findings:

• 50.9% of the nearly 56,000 eligible clinicians wrote at least one buprenorphine prescription within the 22-month period studied.
• Clinicians waivered to prescribe buprenorphine for up to 30 patients treated just 11.3% of their allotted capacity. Clinicians waivered for 100 patients treated 23.9% of their capacity, and those with the largest allotment allowed, 275 patients, treated at 36.9% capacity.

“Our findings suggest the need for ongoing efforts to address treatment barriers, including policy efforts to minimize concerns about DEA oversight, increase clinician and care coordination reimbursement, and support waivered clinicians caring for patients,” the authors of the study wrote.

In an article written for Pew that discusses the study’s findings, lead author Alexandra Duncan, DrPH, MPH, and Ian Reynolds, manager of Pew’s substance use prevention and treatment initiative, posit that the waiver required to prescribe buprenorphine “has contributed to stigma by incorrectly implying that OUD should be treated differently from other health conditions and that buprenorphine is more risk than other medications.” This, Duncan and Reynolds argue, dissuades individuals from seeking treatment and clinicians from providing it, as buprenorphine is the only prescription medication that requires clinicians to obtain a waiver to prescribe.

Proposed legislation could create a significant change on this front. Versions of the Mainstreaming Addiction Treatment (MAT) Act have been introduced in both the House and Senate. Among its provisions, the bill would eliminate training and licensure requirements, as well as patient limits, for buprenorphine prescribers, bringing regulations around buprenorphine in line with other prescription medications. The bill has received bipartisan support in both chambers of Congress.