Buprenorphine Prescribing for Opioid Use Disorder in Medical Practices: Can Office-based Outpatient Care Address the Opiate Crisis in the US?

Abstract

BACKGROUND AND AIMS\nOpioid use disorder (OUD) remains a serious public health issue and treating adults with OUD is a major priority in the US. Little is known about trends in the diagnosis of OUD and in buprenorphine prescribing by physicians in office-based medical practices. We sought to characterize OUD diagnoses and buprenorphine prescribing among adults with OUD in the US between 2006 and 2015.\n\n\nDESIGN AND SETTINGS\nWe used a repeated cross-sectional design, based on data from the 2006-2015 National Ambulatory Medical Care Surveys that surveyed nationally representative samples of office-based outpatient physician visits.\n\n\nPARTICIPANTS\nAdult patients aged 18 or older with a diagnosis of OUD (n=1,034 unweighted) were included.\n\n\nMEASUREMENTS\nBuprenorphine prescribing was defined by whether visits involved buprenorphine or buprenorphine-naloxone, or not. We also examined other covariates (e.g., age, gender, race, and psychiatric co-morbidities).\n\n\nFINDINGS\nWe observed an almost tripling of the diagnosis of OUD from 0.14% in 2006-2010 to 0.38% in 2011-2015 in office-based medical practices (p<0.001). Among adults diagnosed with OUD, buprenorphine prescribing increased from 56.1% in 2006-2010 to 73.6% in 2011-2015 (p=0.126) Adults with OUD were less likely to receive buprenorphine prescriptions if they were Hispanic (adjusted odds ratio [AOR]=0.26; 95% confidence intervals [CI]=0.11, 0.60), had Medicaid insurance (AOR=0.27; 95% CI=0.10, 0.74), or were diagnosed with other psychiatric disorders (AOR=0.45; 95% CI=0.25, 0.83) or substance use disorders (AOR=0.19; 95% CI=0.09, 0.41).\n\n\nCONCLUSIONS\nIn office-based medical practices in the US, diagnoses for opioid use disorder (OUD) and buprenorphine prescriptions for adults with OUD increased from 0.14% and 56.1%, respectively, in 2006-10 to 0.38% and 73.6% in 2011-15.