Midwest and Mid-Atlantic States Face Provider Shortage to Address Opioid Epidemic

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New research from Avalere Health finds 11 states and DC lack an adequate number of providers certified to prescribe buprenorphine, a medicine used to prevent relapse in people with opioid dependence.
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Medication-assisted treatment (MAT), including buprenorphine, is considered the gold standard in addiction care. Addiction experts point to expanding access to Food and Drug Administration-approved MAT as integral to fighting the nation’s opioid crisis. Additionally, a recent survey of addiction experts found that they would devote the most resources to treatment options, especially MAT, to address the ongoing opioid crisis.

To expand access to MAT, the Comprehensive Addiction and Recovery Act (CARA) of 2016 allows nurse practitioners and physician assistants to seek a federal waiver to prescribe buprenorphine for opioid use disorder. Nurse practitioners and physician assistants must complete 24 hours of training to obtain the waiver from the Drug Enforcement Agency. Under the waiver, they can treat a maximum of 30 patients per year. Even with policies designed to increase the number of providers who can prescribe buprenorphine, however, the availability of providers is uneven across states.

Avalere’s analysis finds that 11 states (IA, IL, MD, MI, MO, NC, NH, OH, VA, WI, WV) located in the Midwest and Mid-Atlantic and DC have significantly lower-than-average rates of providers who prescribe buprenorphine compared to opioid overdose deaths (Figure 1). The number of opioid overdose deaths is one way to measure rates of abuse in a state, which may signal a need for more providers who are able to prescribe addiction treatments. On average, there are 1.6 opioid overdoses per buprenorphine prescriber nationwide. Another nine states (AZ, KY, MN, NV, OK, SC, SD TN, UT) have lower rates of prescribers per overdose than the national average.

“For individuals who are struggling with opioid dependence, buprenorphine can be a critical step in their road to recovery,” said Caroline Pearson, senior vice president at Avalere. “Extending prescribing privileges to nurse practitioners and physician assistants can facilitate access to this evidence-based treatment.”

Map of providers who prescribe buprenorphine compared to opioid overdose deaths

“Although more providers are now able to prescribe buprenorphine, there appears to be a shortage of prescribers in many states,” said Clara Soh, a director at Avalere. “Evaluating ways to narrow this gap, including bringing state scope-of-practice laws into alignment with federal regulations, would enable policymakers to achieve their goal to expand access.”

Opioid limit laws


Avalere analyzed drug overdose deaths using Centers for Disease Control and Prevention (CDC) data, based on the following ICD-10 codes: X40, X41, X42, X43, X44, X60, X61, X62, X63, Z64, X85, Y10, Y11, Y12, Y13, and Y14; along with the following contributing causes: T40.0, T40.1, T40.2, T.40.3, T40.3. Some data may have been suppressed by CDC due to small sample size to ensure confidentiality.

Avalere used the Substance Abuse and Mental Health Services Administration Treatment Practitioner Locator Database to analyze the number of providers who are certified to prescribe buprenorphine in each state. Avalere analyzed the number of certified providers per reported overdose death and compared each state to the national average to determine which state had a relatively high or low rate of providers, using opioid overdose deaths as a proxy for the severity of the epidemic in each state.

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