Prescribing Practices of Rural Physicians Waivered to Prescribe Buprenorphine

Opioid use disorder is a serious public health burden, especially throughout rural America. Although efforts have been made to increase the availability of buprenorphine (an office-based medication-assisted treatment), more than 60% of rural counties in the U.S. lack a physician with a Drug Enforcement Administration waiver to prescribe it. This study surveyed all rural physicians with a Drug Enforcement Administration waiver in 2016 to prescribe buprenorphine for opioid use disorder in the U.S. and asked about physician’s demographics, prescribing practices, and barriers to prescribing buprenorphine for treatment of opioid use disorder. Although 89.4% of physicians reported having prescribed buprenorphine for opioid use disorder, only 56.2% were currently accepting new patients for treatment. Physicians with a 30-patient waiver were treating, on average, 8.8 patients, but 53% were not treating any patients. Those with a 100-patient waiver were treating, on average, 56.9 patients. Significant practice variations were found throughout the U.S. by Census Division; more physicians in the Pacific Census Division accepted their own patients for treatment with buprenorphine whereas more physicians in the New England Census Divisions accepted patients of other clinicians in their practice. Although most physicians accepted private insurance, significantly fewer physicians in the East South Central and West South Central Census Divisions accepted Medicaid. These findings suggest that without incorporating information about whether or not physicians are accepting new patients, how many patients are being treated, and which patients and reimbursements are accepted, estimating the supply of buprenorphine treatment services using the Drug Enforcement Administration waivered physicians list will overestimate treatment availability. This article is part of a supplement entitled The Behavioral Health Workforce: Planning, Practice, and Preparation, which is sponsored by the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration of the U.S. Department of Health and Human Services.