Guy Gery P, Jones Christopher M, Rikard Michaela, Strahan Andrea E, Zhang Kun, Olsen Yngvild
J Addict Med. 2025 Feb 19. doi: 10.1097/ADM.0000000000001457.
Buprenorphine can decrease opioid use disorder and mortality risk but remains underutilized. This study evaluates changes in monthly buprenorphine dispensing associated with federal policy changes in the United States from 2018 to 2023.
This study used interrupted time series analysis comparing the monthly rate of patients dispensed buprenorphine after the implementation of telehealth flexibilities in March 2020, relaxation of training requirements in April 2021, and removal of waiver requirements in December 2022. Buprenorphine formulated for opioid use disorder was included from the IQVIA Total Patient Tracker.
Before March 2020, the monthly rate of individuals dispensed buprenorphine was increasing. The rate of increase slowed after each policy change: -0.69 (95% CI=-1.00 to -0.39) after telehealth flexibilities were initiated, -0.60 (95% CI=-0.92 to -0.27) after relaxing training requirements, and -0.49 (95% CI=-0.73 to -0.24) after waiver elimination. After the elimination of the waiver, declines were observed across several specialty groups, including pain medicine, emergency medicine, and primary care, while the rate increased among addiction medicine specialists.
After each policy change, the rate of individuals dispensed buprenorphine increased at a slower rate than before each policy change. These findings suggest that the removal of the waiver, while important, may not be sufficient on its own to meaningfully expand buprenorphine prescribing. Individual and systems-level strategies may be needed to fully optimize the impact of these policy changes focusing on reducing patient, clinician, and institutional stigma, addressing clinician barriers, implementing systems-level improvements, and strengthening payment policies that incentivize prescribing.
丁丙诺啡可降低阿片类药物使用障碍和死亡风险，但使用率仍然较低。本研究评估了2018年至2023年美国联邦政策变化与每月丁丙诺啡配药情况的变化。
本研究采用中断时间序列分析，比较了2020年3月实施远程医疗灵活性措施、2021年4月放宽培训要求以及2022年12月取消豁免要求后每月接受丁丙诺啡配药的患者比例。用于阿片类药物使用障碍的丁丙诺啡数据来自艾昆纬全患者追踪系统。
2020年3月之前，每月接受丁丙诺啡配药的人数比例呈上升趋势。每次政策变化后，上升速度放缓：实施远程医疗灵活性措施后为-0.69（95%置信区间=-1.00至-0.39），放宽培训要求后为-0.60（95%置信区间=-0.92至-0.27），取消豁免后为-0.49（95%置信区间=-0.73至-0.24）。取消豁免后，包括疼痛医学、急诊医学和初级保健在内的多个专科组出现下降，而成瘾医学专科医生的配药率上升。
每次政策变化后，接受丁丙诺啡配药的人数比例上升速度均慢于政策变化前。这些发现表明，取消豁免虽然重要，但仅靠这一点可能不足以显著扩大丁丙诺啡的处方量。可能需要个人层面和系统层面的策略，以充分优化这些政策变化的影响，重点是减少患者、临床医生和机构的耻辱感，解决临床医生面临的障碍，实施系统层面的改进，以及加强激励处方的支付政策。
