Filling the Treatment Gap: Geographic Expansion of Buprenorphine Providers Across the U.S.

Introduction

With opioid-related deaths reaching epidemic levels, gaining a better understanding of access to treatment for opioid use disorder is critical. Buprenorphine is an effective medication for the treatment of opioid addiction. The analysis is critical post–X-waiver elimination, which extended the ability to prescribe buprenorphine for the treatment of opioid use disorder to all practitioners with Drug Enforcement Agency Schedules II–V on their Drug Enforcement Agency registration. The primary purpose of the analysis was to explore the geographic patterns of substance use treatment and establish a geographic baseline to assess the removal of the X-waiver in the future.

Methods

The authors assessed the expansion of buprenorphine providers across the data from all U.S. counties up to December 31, 2022. The authors used all certified buprenorphine providers' data from the database of the buprenorphine waiver notification system. The authors used county-level population data from the U.S. Census of American Community Survey of 2021 and the Centers for Disease Prevention and Control's drug-related mortality data. The authors implemented spatial scan statistics to identify the spatial clusters using SaTScan.

Results

The results from this analysis show that Doctor of Medicine/Doctor of Osteopathic Medicine have the highest numbers of certified providers at 8,134 (65.08%) in 2018 and 14,525 (57.87%) in 2022. This analysis shows that the distribution of buprenorphine providers across the counties of the U.S. was significantly clustered. Higher clusters with RR >1 (p<0.001) were found in the states of Washington, Oregon, and Northern California and the Western borders of Montana. Similar clusters of counties with RR >1 (p<0.001) were found in the northeastern states of Maine, Vermont, and New Hampshire.

Conclusions

From this analysis, it is evident that buprenorphine-certified providers are clustered in areas of higher drug-related mortality filling a treatment gap. The elimination of the X-waiver will be a significant step toward increasing access to medication for opioid use disorder, and this analysis may be used as a geographic baseline to assess in the future.