Countries that want to increase access to buprenorphine, a life-saving drug used to treat opioid use disorders, should consider efforts to increase professional education and clinician knowledge, according to a new RAND Corporation study.
Researchers who examined six state-level policies aimed at promoting buprenorphine use found that buprenorphine prescribers should be required to receive additional education beyond that initially required and medical education about substance abuse should be provided. They found that both continuing were associated with significant increases in buprenorphine use. treatment.
Findings will be published in the latest edition of the journal JAMA Health Forum.
“A number of studies suggest that doctors and other health care providers are unsure whether they know enough about using buprenorphine to treat opioid use disorder,” said the study. said lead author Bradley D. Stein, a medical scientist at the nonprofit research institute Rand. “We have found that requesting additional continuing education helps address this concern and allows us to make better use of our training.”
This study analyzed the impact of six different state-level policies. One is a rule that requires buprenorphine prescribers to undergo additional education beyond the previously mandated X-waiver training. Continue medical education on substance abuse and addiction. Expand Medicaid coverage to buprenorphine treatment. Expand Medicaid coverage across the board. Require prescribers to use a prescription drug monitoring program. Regulation of pain management clinics.
The number of fatal opioid overdoses continues to soar in the United States, with an estimated 5.6 million people in the country having an opioid use disorder. Drug treatment of opioid use disorders is considered standard care, improving quality of life and reducing fatal overdose rates.
A new study used records documenting 90% of prescriptions filled in US retail pharmacies to identify buprenorphine prescriptions filled between 2006 and 2018. The researchers used a variety of sources to identify when states implemented any of the six policies under review.
The researchers analyzed records to identify new episodes of buprenorphine treatment for opioid use disorder and compared trends in drug use with when states adopted different policies. Results were summarized at the county level, taking into account local characteristics that may influence buprenorphine prescribing.
The researchers found that national buprenorphine use increased sharply during the study period. Months of buprenorphine treatment per 1,000 people increased from 1.5 months in 2006 to 22.8 months in 2018.
The data suggest that, during this period, requiring education of buprenorphine prescribers beyond the initial training required for exemption was associated with a significant increase in months of buprenorphine treatment per person in the year following implementation of such a policy. showed that they are related.
Under such regulations, buprenorphine use increased by approximately 9 months of therapy per 1,000 population in the first year, and increased to over 14 months of therapy per 1,000 population in the fifth year after implementation.
Requiring continuing medical education in substance abuse and addiction for medical licenses was also associated with the increase. Under such regulations, buprenorphine use increased by approximately 7 months of therapy per 1,000 population in the first year, to over 11 months of therapy per 1,000 population in the fifth year.
The study found that prescription drug monitoring programs, pain management clinic legislation, and Medicaid policies were not associated with buprenorphine dispensing.
“Our findings suggest that mandatory education of buprenorphine prescribers and training of health care workers in the treatment of substance use disorders will increase buprenorphine use and ultimately serve more patients. ,” said RAND-USC Schaefer, Director of the Opioid Policy Tool and Information Center. “The potential benefits of training in treating patients with substance use disorders are particularly important given that the recently passed Federal Consolidated Appropriations Act mandates such training for most prescribing clinicians.”
Support for this research was provided by the Opioid Initiatives Foundation and the National Institute on Drug Abuse at the National Institutes of Health with award numbers P50DA046351, R01DA048500, and K01DA042139. The contents of this release are the sole responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.
The other author of the study is Brendan K. Saloner of the Johns Hopkins Bloomberg School of Public Health. Olivia K. Golan, Georgia State University School of Public Health. Barbara Andraka Christo of the University of Central Florida. Christina Andrews of the University of South Carolina Arnold School of Public Health. Andrew W. Dick and Flora Shen, both from the RAND Corporation. Corey S. Davis of Public Health Law Network. and Adam J. Gordon of VA Salt Lake City Health Care System.
RAND Health Care promotes healthier societies by improving healthcare systems in the United States and beyond.
