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Article ; Online: Laws for expanding access to medications for opioid use disorder: a legal analysis of 16 states & Washington D.C.

Andraka-Christou, Barbara / Saloner, Brendan / Gordon, Adam J / Totaram, Rachel / Randall-Kosich, Olivia / Golan, Matthew / Stein, Bradley D

The American journal of drug and alcohol abuse

2022 Volume 48, Issue 4, Page(s) 492–503

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Analgesics, Opioid/therapeutic use ; Buprenorphine/therapeutic use ; Health Services Accessibility ; Humans ; Methadone/therapeutic use ; Opiate Substitution Treatment/methods ; Opioid-Related Disorders/drug therapy ; Washington
Chemical Substances	Analgesics, Opioid ; Buprenorphine (40D3SCR4GZ) ; Methadone (UC6VBE7V1Z)
Language	English
Publishing date	2022-06-30
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	193086-2
ISSN	1097-9891 ; 0095-2990
ISSN (online)	1097-9891
ISSN	0095-2990
DOI	10.1080/00952990.2022.2082301
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Article ; Online: Growing importance of high-volume buprenorphine prescribers in OUD treatment: 2009-2018.

Schuler, Megan S / Dick, Andrew W / Gordon, Adam J / Saloner, Brendan / Kerber, Rose / Stein, Bradley D

Drug and alcohol dependence

2024 Volume 259, Page(s) 111290

Abstract: Background: We examined the number and characteristics of high-volume buprenorphine prescribers and the nature of their buprenorphine prescribing from 2009 to 2018.: Methods: In this observational cohort study, IQVIA Real World retail pharmacy claims ...

Abstract	Background: We examined the number and characteristics of high-volume buprenorphine prescribers and the nature of their buprenorphine prescribing from 2009 to 2018. Methods: In this observational cohort study, IQVIA Real World retail pharmacy claims data were used to characterize trends in high-volume buprenorphine prescribers (clinicians with a mean of 30 or more active patients in every month that they were an active prescriber) during 2009-2018. Very high-volume prescribing (mean of 100+ patients per month) was also examined. Results: Overall, 94,491 clinicians prescribed buprenorphine dispensed during 2009-2018. The proportion of active prescribers meeting high-volume criteria increased from 7.4 % in 2009 to 16.7 % in 2018. High-volume prescribers accounted for 80 % of dispensed buprenorphine prescriptions during 2009-2018; very high-volume prescribers accounted for 26 %. Adult primary care physicians consistently comprised the majority of high-volume prescribers. Addiction specialists were much more likely to be high-volume prescribers compared to other specialties, including psychiatrists and pain specialists. By 2018, the proportion of prescriptions from high-volume prescribers paid by Medicaid had doubled to 40 %, accompanied by a decline in both self-pay and commercial insurance. High-volume prescribers were overwhelmingly concentrated in urban counties with the highest fatal overdose rates. In 2018, the highest density of high-volume prescribers was in New England and the mid-Atlantic region. Conclusions: Growth in high-volume prescribers outpaced the overall growth in buprenorphine prescribers across 2009-2018. High-volume prescribers play an increasingly central role in providing medication for OUD in the U.S., yet results indicate key regional variation in the availability of high-volume buprenorphine prescribers.
Language	English
Publishing date	2024-04-16
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2024.111290
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Zs.A 1310: Show issues

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Article ; Online: Prescription Drug Dispensing and Patient Costs After Implementation of a No Behavioral Health Cost-Sharing Law.

Golberstein, Ezra / Campbell, James M / Maclean, Johanna Catherine / Harris, Samantha J / Saloner, Brendan / Stein, Bradley D

JAMA health forum

2024 Volume 5, Issue 3, Page(s) e240198

Abstract: Importance: On January 1, 2022, New Mexico implemented a No Behavioral Cost-Sharing (NCS) law that eliminated cost-sharing for mental health and substance use disorder (MH/SUD) treatments in plans regulated by the state, potentially reducing a barrier ... ...

Abstract	Importance: On January 1, 2022, New Mexico implemented a No Behavioral Cost-Sharing (NCS) law that eliminated cost-sharing for mental health and substance use disorder (MH/SUD) treatments in plans regulated by the state, potentially reducing a barrier to treatment for MH/SUDs among the commercially insured; however, the outcomes of the law are unknown. Objective: To assess the association of implementation of the NCS with out-of-pocket spending for prescription for drugs primarily used to treat MH/SUDs and monthly volume of dispensed drugs. Design, settings, and participants: This retrospective cohort study used a difference-in-differences research design to examine trends in outcomes for New Mexico state employees, a population affected by the NCS, compared with federal employees in New Mexico who were unaffected by NCS. Data were collected on prescription drugs for MH/SUDs dispensed per month between January 2021 and June 2022 for New Mexico patients with a New Mexico state employee health plan and New Mexico patients with a federal employee health plan. Data analysis occurred from December 2022 to January 2024. Exposure: Enrollment in a state employee health plan or federal health plan. Main outcomes and measures: The primary outcomes were mean patient out-of-pocket spending per dispensed MH/SUD prescription and the monthly volume of dispensed MH/SUD prescriptions per 1000 employees. A difference-in-differences estimation approach was used. Results: The implementation of the NCS law was associated with a mean (SE) $6.37 ($0.30) reduction (corresponding to an 85.6% decrease) in mean out-of-pocket spending per dispensed MH/SUD medication (95% CI, -$7.00 to -$5.75). The association of implementation of NCS with the volume of prescriptions dispensed was not statistically significant. Conclusions and relevance: These findings suggest that the implementation of the New Mexico NCS law was successful in lowering out-of-pocket spending on prescription medications for MH/SUDs, but that there was no association of NCS with the volume of medications dispensed in the first 6 months after implementation. A key challenge is to identify policies that protect from high out-of-pocket spending while also promoting access to needed care.
MeSH term(s)	Humans ; Prescription Drugs/therapeutic use ; Retrospective Studies ; Cost Sharing ; Health Expenditures ; Substance-Related Disorders/drug therapy ; Health Care Costs
Chemical Substances	Prescription Drugs
Language	English
Publishing date	2024-03-01
Publishing country	United States
Document type	Journal Article
ISSN	2689-0186
ISSN (online)	2689-0186
DOI	10.1001/jamahealthforum.2024.0198
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Article ; Online: Will the End of the X-Waiver Expand Access to Buprenorphine Treatment? Achieving the Full Potential of the 2023 Consolidated Appropriations Act.

Saloner, Brendan / Andraka-Christou, Barbara / Stein, Bradley D / Gordon, Adam J

Substance abuse

2023 Volume 44, Issue 3, Page(s) 108–111

Abstract: The 2023 Consolidated Appropriations Act repealed the special waiver for prescribing buprenorphine to patients with opioid use disorder, a bipartisan goal long sought by advocates. The change has symbolic importance in recognizing that buprenorphine is a ...

Abstract	The 2023 Consolidated Appropriations Act repealed the special waiver for prescribing buprenorphine to patients with opioid use disorder, a bipartisan goal long sought by advocates. The change has symbolic importance in recognizing that buprenorphine is a mainstream medical treatment. We argue that the maximum potential of the law can be achieved by addressing three bottlenecks. First, it is important that new training requirements for all controlled substances prescribers be grounded in scientific principles of addiction treatment and are robustly evaluated to ensure they meet quality standards. Second, even with the elimination of the waiver, there are potential constraints from state law such as state-specific requirements that practitioners require counseling or obtain a separate credential, and many states also have limiting scope of practice regulations. We recommend that these requirements are eased wherever possible to improve treatment access. Third, it is critical to build onramps to treatment in settings such as primary care, hospitals, and correctional facilities. While we anticipate that buprenorphine prescribing will primarily occur in high-volume practices, there is the potential to activate a broader workforce to serve as entry points to care. We conclude that the stage is set for significant increases in lifesaving treatment but the difficult task ahead is ensuring that the resources and training are available to build strong capacity.
MeSH term(s)	Humans ; Buprenorphine/therapeutic use ; Opiate Substitution Treatment ; Opioid-Related Disorders/drug therapy ; Surveys and Questionnaires ; Credentialing
Chemical Substances	Buprenorphine (40D3SCR4GZ)
Language	English
Publishing date	2023-09-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	1458030-5
ISSN	1547-0164 ; 0889-7077
ISSN (online)	1547-0164
ISSN	0889-7077
DOI	10.1177/08897077231186212
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Article ; Online: Buprenorphine Opioid Treatment During the COVID-19 Pandemic-Reply.

Nguyen, Thuy D / Saloner, Brendan / Stein, Bradley D

JAMA internal medicine

2021 Volume 181, Issue 8, Page(s) 1135–1136

MeSH term(s)	Analgesics, Opioid/therapeutic use ; Buprenorphine/therapeutic use ; COVID-19 ; Humans ; Opiate Substitution Treatment ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; Opioid-Related Disorders/prevention & control ; Pandemics ; SARS-CoV-2
Chemical Substances	Analgesics, Opioid ; Buprenorphine (40D3SCR4GZ)
Language	English
Publishing date	2021-04-11
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2699338-7
ISSN	2168-6114 ; 2168-6106
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2021.0774
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Ua VI Zs.119: Show issues

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Article ; Online: Association of Patients' Direct Addition of Buprenorphine to Urine Drug Test Specimens With Clinical Factors in Opioid Use Disorder.

Pytell, Jarratt D / Whitley, Penn / Passik, Steven D / Bundy, William L / Dawson, Eric / Saloner, Brendan

JAMA psychiatry

2023 Volume 80, Issue 5, Page(s) 459–467

Abstract: Importance: The direct addition of buprenorphine to urine drug test specimens to mimic results suggestive of adherence is a clinically significant result, yet little is known about the phenomenon.: Objective: To characterize factors associated with ... ...

Abstract	Importance: The direct addition of buprenorphine to urine drug test specimens to mimic results suggestive of adherence is a clinically significant result, yet little is known about the phenomenon. Objective: To characterize factors associated with the direct addition of buprenorphine to urine specimens among patients prescribed buprenorphine for opioid use disorder. Design, setting, and participants: This cross-sectional study of urine drug test specimens was conducted from January 1, 2017, to April 30, 2022, using a national database of urine drug test specimens ordered by clinicians from primary care, behavioral health, and substance use disorder treatment clinics. Urine specimens with quantitative norbuprenorphine and buprenorphine concentrations from patients with opioid use disorder currently prescribed buprenorphine were analyzed. Exposures: Nonprescribed opioid or stimulant co-positive, clinical setting, collection year, census division, patient age, patient sex, and payor. Main outcomes and measures: Norbuprenorphine to buprenorphine ratio less than 0.02 identified direct addition of buprenorphine. Unadjusted trends in co-positivity for stimulants and opioids were compared between specimens consistent with the direct addition of buprenorphine. Factors associated with the direct addition of buprenorphine were examined with generalized estimating equations. Results: This study included 507 735 urine specimens from 58 476 patients. Of all specimens, 261 210 (51.4%) were obtained from male individuals, and 137 254 (37.7%) were from patients aged 25 to 34 years. Overall, 9546 (1.9%) specimens from 4550 (7.6%) patients were suggestive of the direct addition of buprenorphine. The annual prevalence decreased from 2.4% in 2017 to 1.2% in 2020. Opioid-positive with (adjusted odds ratio [aOR], 2.01; 95% CI, 1.85-2.18) and without (aOR, 2.02; 95% CI, 1.81-2.26) stimulant-positive specimens were associated with the direct addition of buprenorphine to specimens, while opioid-negative/stimulant-positive specimens were negatively associated (aOR, 0.78; 95% CI, 0.71-0.85). Specimens from patients aged 35 to 44 years (aOR, 1.59; 95% CI, 1.34-1.90) and primary care (aOR, 1.60; 95% CI, 1.44-1.79) were associated with the direct addition of buprenorphine. Differences by treatment setting decreased over time. Specimens from the South Atlantic census region had the highest association (aOR, 1.4; 95% CI, 1.25-1.56) and New England had the lowest association (aOR, 0.54; 95% CI, 0.46-0.65) with the direct addition of buprenorphine. Conclusions and relevance: In this cross-sectional study, the direct addition of buprenorphine to urine specimens was associated with other opioid positivity and being collected in primary care settings. The direct addition of buprenorphine to urine specimens is a clinically significant finding, and best practices specific for this phenomenon are needed.
MeSH term(s)	Humans ; Male ; Analgesics, Opioid/therapeutic use ; Cross-Sectional Studies ; Buprenorphine/therapeutic use ; Opioid-Related Disorders/drug therapy ; Substance Abuse Detection/methods ; Opiate Substitution Treatment/methods
Chemical Substances	Analgesics, Opioid ; Buprenorphine (40D3SCR4GZ)
Language	English
Publishing date	2023-03-22
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2701203-7
ISSN	2168-6238 ; 2168-622X
ISSN (online)	2168-6238
ISSN	2168-622X
DOI	10.1001/jamapsychiatry.2023.0234
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Article ; Online: Advanced Practice Providers and Buprenorphine Access in the United States After the Comprehensive Addiction and Recovery Act.

Lee, Dennis / Saloner, Brendan / Barnett, Michael

Psychiatric services (Washington, D.C.)

2021 Volume 72, Issue 11, Page(s) 1358–1359

MeSH term(s)	Buprenorphine/therapeutic use ; Humans ; Narcotic Antagonists/therapeutic use ; Opiate Substitution Treatment ; Opioid-Related Disorders/drug therapy ; Opioid-Related Disorders/epidemiology ; United States
Chemical Substances	Narcotic Antagonists ; Buprenorphine (40D3SCR4GZ)
Language	English
Publishing date	2021-10-27
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural
ZDB-ID	1220173-x
ISSN	1557-9700 ; 1075-2730
ISSN (online)	1557-9700
ISSN	1075-2730
DOI	10.1176/appi.ps.202100122
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Article ; Online: Exploring the Association of State Policies and the Trajectories of Buprenorphine Prescriber Patient Caseloads.

Griffin, Beth Ann / Cabreros, Irineo / Saloner, Brendan / Gordon, Adam J / Kerber, Rose / Stein, Bradley D

Substance abuse

2023 Volume 44, Issue 3, Page(s) 136–145

Abstract: Background: Increasing buprenorphine access is critical to facilitating effective opioid use disorder treatment. Buprenorphine prescriber numbers have increased substantially, but most clinicians who start prescribing buprenorphine stop within a year, ... ...

Abstract	Background: Increasing buprenorphine access is critical to facilitating effective opioid use disorder treatment. Buprenorphine prescriber numbers have increased substantially, but most clinicians who start prescribing buprenorphine stop within a year, and most active prescribers treat very few individuals. Little research has examined state policies' association with the evolution of buprenorphine prescribing clinicians' patient caseloads. Methods: Our retrospective cohort study design derived from 2006 to 2018 national pharmacy claims identifying buprenorphine prescribers and the number of patients treated monthly. We defined persistent prescribers based on results from a Results: Medicaid coverage of buprenorphine was associated with a smaller percentage of new prescribers becoming persistent prescribers (OR = 0.72; 95% CI = 0.53, 0.97). There was no evidence that either mandatory counseling or prior authorization was associated with the odds of a clinician being a persistent prescriber with estimated ORs equal to 0.85 (95% CI = 0.63, 1.16) and 1.13 (95% CI = 0.83, 1.55), respectively. Conclusions: Compared to states without coverage, states with Medicaid coverage for buprenorphine had a smaller percentage of new prescribers become persistent prescribers; there was no evidence that the other state policies were associated with changes in the rate of clinicians becoming persistent prescribers. Because buprenorphine treatment is highly concentrated among a small group of clinicians, it is imperative to increase the pool of clinicians providing care to larger numbers of patients for longer periods. Greater efforts are needed to identify and support factors associated with successful persistent prescribing.
MeSH term(s)	United States ; Humans ; Buprenorphine/therapeutic use ; Opioid-Related Disorders/drug therapy ; Retrospective Studies ; Opiate Substitution Treatment ; Policy ; Analgesics, Opioid/therapeutic use
Chemical Substances	Buprenorphine (40D3SCR4GZ) ; Analgesics, Opioid
Language	English
Publishing date	2023-07-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	1458030-5
ISSN	1547-0164 ; 0889-7077
ISSN (online)	1547-0164
ISSN	0889-7077
DOI	10.1177/08897077231179824
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Article ; Online: Utilization of Medications for Opioid Use Disorder Among West Virginia Medicaid Enrollees Following Medicaid Coverage of Methadone.

Harris, Samantha J / Landis, Rachel K / Li, Wenshu / Stein, Bradley D / Saloner, Brendan

Substance use & addiction journal

2023 Volume 45, Issue 1, Page(s) 91–100

Abstract: Background: West Virginia entered an institution for mental disease Section 1115 waiver with the Centers for Medicare & Medicaid Services in 2018, which allowed Medicaid to cover methadone at West Virginia's nine opioid treatment programs (OTPs) for the ...

Abstract	Background: West Virginia entered an institution for mental disease Section 1115 waiver with the Centers for Medicare & Medicaid Services in 2018, which allowed Medicaid to cover methadone at West Virginia's nine opioid treatment programs (OTPs) for the first time. Methods: We conducted time trend and geospatial analyses of Medicaid enrollees between 2016 and 2019 to examine medications for opioid use disorder utilization patterns following Medicaid coverage of methadone, focusing on distance to an OTP as a predictor of initiating methadone and conditional on receiving any, longer treatment duration. Results: Following Medicaid coverage of methadone in 2018, patients receiving methadone comprised 9.5% of all Medicaid enrollees with an opioid use disorder (OUD) diagnosis and 10.6% in 2019 ( Conclusions: West Virginia Medicaid's new methadone coverage was associated with an influx of new enrollees with OUD, many of whom had no previous OUD diagnosis or prior Medicaid enrollment. Methadone patients frequently traveled far distances for treatment, suggesting that the state needs additional OTPs and innovative methadone delivery models to improve availability.
MeSH term(s)	Aged ; United States/epidemiology ; Humans ; Methadone/therapeutic use ; Medicaid ; West Virginia/epidemiology ; Medicare ; Opioid-Related Disorders/drug therapy ; Analgesics, Opioid/therapeutic use
Chemical Substances	Methadone (UC6VBE7V1Z) ; Analgesics, Opioid
Language	English
Publishing date	2023-03-08
Publishing country	United States
Document type	Journal Article
ISSN	2976-7350
ISSN (online)	2976-7350
DOI	10.1177/29767342231208516
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Article ; Online: National Trends in Buprenorphine Treatment for Opioid Use Disorder From 2007 to 2018.

Schuler, Megan S / Saloner, Brendan / Gordon, Adam J / Dick, Andrew W / Stein, Bradley D

Substance abuse

2023 Volume 44, Issue 3, Page(s) 154–163

Abstract: Background: Buprenorphine is a key medication to treat opioid use disorder (OUD). Since its approval in 2002, buprenorphine access has grown markedly, spurred by major federal and state policy changes. This study characterizes buprenorphine treatment ... ...

Abstract	Background: Buprenorphine is a key medication to treat opioid use disorder (OUD). Since its approval in 2002, buprenorphine access has grown markedly, spurred by major federal and state policy changes. This study characterizes buprenorphine treatment episodes during 2007 to 2018 with respect to payer, provider specialty, and patient demographics. Methods: In this observational cohort study, IQVIA Real World pharmacy claims data were used to characterize trends in buprenorphine treatment episodes across four time periods: 2007-2009, 2010-2012, 2013-2015, and 2016-2018. Results: In total, we identified more than 4.1 million buprenorphine treatment episodes among 2 540 710 unique individuals. The number of episodes doubled from 652 994 in 2007-2009 to 1 331 980 in 2016-2018. Our findings indicate that the payer landscape changed dramatically, with the most pronounced growth observed for Medicaid (increased from 17% of episodes in 2007-2009 to 37% of episodes in 2016-2018), accompanied by relative declines for both commercial insurance (declined from 35 to 21%) and self-pay (declined from 27 to 11%). Adult primary care providers (PCPs) were the dominant prescribers throughout the study period. The number of episodes among adults older than 55 increased more than 3-fold from 2007-2009 to 2016-2018. In contrast, youth under age 18 experienced an absolute decline in buprenorphine treatment episodes. Buprenorphine episodes increased in length from 2007-2018, particularly among adults over age 45. Conclusions: Our findings demonstrate that the U.S. experienced clear growth in buprenorphine treatment-particularly for older adults and Medicaid beneficiaries-reflecting some key health policy and implementation success stories. Yet, since the prevalence of OUD and fatal overdose rate have also approximately doubled during this period, the observed growth in buprenorphine treatment did not demonstrably impact the pronounced treatment gap. To date, only a minority of individuals with OUD currently receive treatment, indicating continued need for systemic efforts to equitably improve treatment uptake.
MeSH term(s)	Adolescent ; United States/epidemiology ; Humans ; Aged ; Middle Aged ; Buprenorphine/therapeutic use ; Opiate Substitution Treatment/methods ; Opioid-Related Disorders/epidemiology ; Medicaid ; Cohort Studies ; Analgesics, Opioid/therapeutic use
Chemical Substances	Buprenorphine (40D3SCR4GZ) ; Analgesics, Opioid
Language	English
Publishing date	2023-06-06
Publishing country	United States
Document type	Observational Study ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1458030-5
ISSN	1547-0164 ; 0889-7077
ISSN (online)	1547-0164
ISSN	0889-7077
DOI	10.1177/08897077231179576
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