Buprenorphine prescription dispensing rates and characteristics following federal changes in prescribing policy, 2017-2018: A cross-sectional study

•The number of buprenorphine prescriptions dispensed increase 9.1% from from 2017 to 2018.•Buprenorphine prescribing by nurse practitioners and physician assistants increased the most.•County-level factors were associated with buprenorphine dispensing rates.•Buprenorphine prescriptions among nurse practitioners and physician assistants was 1.3 times greater in rural counties.•Recent legislative and regulatory efforts may have played a role in increased buprenorphine dispensing. Expansion of buprenorphine for opioid use disorder treatment is a core component of the opioid overdose epidemic response. The Comprehensive Addiction and Recovery Act (CARA) of 2016 authorized nurse practitioners (NPs) and physician assistants (PAs) to obtain a DATA-waiver to prescribe buprenorphine. The objectives of this study are to examine national- and county-level buprenorphine prescription dispensing, patterns by patient demographics and clinician specialty, and county-level characteristics associated with buprenorphine dispensing. Retrospective analysis of buprenorphine prescriptions dispensed from approximately 92% of all retail prescriptions in the US (2017–2018). Analyses include rates of buprenorphine prescriptions dispensed, by patient demographics and prescriber specialty, changes in buprenorphine prescriptions dispensed at the national- and county-level, and county-level characteristics associated with buprenorphine dispensing. Buprenorphine prescriptions dispensed increased by 9.1% nationally, from 40.7–44.4 per 1000 residents. From 2017 to 2018, NPs (351.9%) and PAs (257.3%) had the largest percent increases in dispensed buprenorphine prescriptions, accounting for 79.6% of the total increase. In 2018, county-level characteristics associated with high buprenorphine dispensing included. among others: greater potential buprenorphine treatment capacity, higher drug overdose death rates, and higher rates of Medicaid enrollment. Rural counties were associated with low buprenorphine dispensing. Buprenorphine dispensing rates increased in the US from 2017 to 2018, suggesting the addition of NPs and PAs by CARA has contributed to an increase in dispensed buprenorphine prescriptions.