PhD Candidate Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY, USA Lexington, United States
Background: Buprenorphine is a partial opioid agonist used for the treatment of opioid use disorder (OUD). Until December 2022, federal regulations required qualifying practitioners to receive a waiver to prescribe buprenorphine medication for OUD (MOUD) in an “office-based setting”. In mid-2016, the final rule of Drug Addiction Treatment Act of 2000 (i.e., increased patient limit) and the Comprehensive Addiction and Recovery Act of 2016 (i.e., introduced nurse practitioners and physician assistants as qualifying practitioners) expanded buprenorphine treatment availability. Texas has the second largest number of people with OUD (~146k) and the impact of these policies on prescribing measures in the state remains unknown.
Objectives: We aimed to evaluate the association between the implementation of these federal policies and 1) the buprenorphine MOUD dispensing rate; and 2) the units of buprenorphine MOUD dispensed per prescription in Texas.
Methods: Texas prescription drug monitoring program dispensing data (January 2015 to September 2018) was used to compare these two outcomes pre- and post-September 2016. We used multivariable generalized linear models with county and month fixed effects, including a subgroup analysis by county metropolitan status using the 2013 Rural-Urban Continuum Codes.
Results: During the study period, there were 1,610,827 buprenorphine MOUD dispensations in 243 Texas counties. The 2016 federal expansion was associated with 13.2% (95% confidence interval = 3.9-23.3%) increase in buprenorphine MOUD dispensing rate per 10,000 people and 18.1% (7.6-29.6%) increase in median buprenorphine MOUD units filled per prescription. The expansions were associated with an increased dispensing rate in small non-metropolitan counties (n=39; 76.5%; 32.2-135.7%) and with an increase in median units dispensed in metropolitan (n=82; 22.9%; 10.6-36.6%), large non-metropolitan (n=19; 28.0%; 5.9-54.7%), and medium non-metropolitan (n=103; 23.7%; 5.1-45.4%) counties.
Conclusions: The 2016 federal legislation changes aimed at increasing buprenorphine MOUD prescribing were associated with increase in buprenorphine MOUD dispensing rate and the units of buprenorphine MOUD filled in Texas. Differences by counties’ metropolitan status exist; the dispensing rate was almost doubled in small non-metropolitan counties. These results suggest that the recent (2023) removal of buprenorphine prescribing waiver requirement may impact dispensing rates in Texas counties according to metropolitan status.
