How Accessible is Office-based Buprenorphine Treatment in the US?

Buprenorphine is a highly effective treatment for opioid use disorder (OUD). Despite the ostensible availability of buprenorphine in traditional office-based US medical practices, only a minority of individuals with OUD receive it. This audit, or “secret shopper,” study involved research staff posing as a 30 year-old female with heroin use to evaluate access to new patient appointments in two scenarios: one with Medicaid, the other as uninsured self-pay. The sample included 546 providers across 5 US states and Washington DC publicly listed in the Substance Abuse and Mental Health Services Administration’s buprenorphine practitioner locator.

• New patient appointments were offered to 54% of Medicaid contacts and 62% of uninsured self-pay contacts.
• Buprenorphine induction on the first visit was available to 27% of Medicaid and 41% of uninsured self-pay contacts.
• The median time to a new patient appointment was 6 days for Medicaid and 5 days for uninsured self-pay contacts.

Comments: These data highlight challenges in accessing evidence-based treatment for OUD, with worse access for individuals with Medicaid compared with uninsured self-pay. Although the authors noted access and wait times for buprenorphine treatment are on par with new patient access to general primary care overall, it is unclear if this level of access is sufficient to engage individuals with OUD. Future studies should examine whether alternative low-threshold models, including those with same-day access, offer substantial improvement in treatment engagement.

Marc R. Larochelle, MD, MPH

Reference: Beetham T, Saloner B, Wakeman SE, et al. Access to office-based buprenorphine treatment in areas with high rates of opioid-related mortality: an audit study. Ann Intern Med. 2019;171(1):1–9.