Buprenorphine prescribing for opioid use disorder in medical practices: can office-based out-patient care address the opiate crisis in the United States?

Abstract

Background and aims: Opioid use disorder (OUD) remains a serious public health issue, and treating adults with OUD is a major priority in the United States. 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 United States between 2006 and 2015.

Design and settings: We used a repeated cross-sectional design, based on data from the 2006-15 National Ambulatory Medical Care Surveys that surveyed nationally representative samples of office-based out-patient physician visits.

Participants: Adult patients aged 18 years or older with a diagnosis of OUD (n = 1034 unweighted) were included.

Measurements: Buprenorphine 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 comorbidities).

Findings: We observed an almost tripling of the diagnosis of OUD from 0.14% in 2006-10 to 0.38% in 2011-15 in office-based medical practices (P < 0.001). Among adults diagnosed with OUD, buprenorphine prescribing increased from 56.1% in 2006-10 to 73.6% in 2011-15 (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 interval (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).

Conclusions: In office-based medical practices in the United States, diagnoses for opioid use disorder and buprenorphine prescriptions for adults with opioid use disorder increased from 0.14 and 56.1%, respectively, in 2006-10 to 0.38 and 73.6% in 2011-15.

Keywords: Buprenorphine; opioid; opioid use disorder; out-patient care; prescribing trends; treatment patterns.

Figure 1.. National trends of opioid use disorder diagnosis among US adults in outpatient care visits by physician specialty, 2006-2015 NAMCS.

Note: Bars represent 95% confidence intervals. P-values are based on the difference of prevalence between 2006-2010 and 2011-2015 using a weight-corrected Pearson’s chi-squared statistic. Other specialties included: general surgery, obstetrics/gynecology, orthopedic surgery, cardiovascular diseases, dermatology, urology, neurology, ophthalmology, otolaryngology, and others.