Access to buprenorphine treatment for opioid use disorders in the context of health reform

Objectives: Buprenorphine treatment occurs primarily in physicians’ offices, making it an exemplar of the health care integration being promoted under the Affordable Care Act (ACA). However, current federal regulations restrict both which physicians can prescribe buprenorphine and the number of patients these physicians can treat, thereby limiting treatment access. The impact of the ACA on access to buprenorphine is unclear. Methods: This mixed methods study integrates data from 21 physician interviews, the DEA’s Controlled Substances Act registrant database, and state characteristics. Interviews were coded using a qualitative description approach. Quantitative analyses examined relationships between states’ approaches to health reform and buprenorphine access, defined as the number of buprenorphine physicians per 1 million residents. Results: Many interview participants anticipated growth in the numbers of insured individuals under ACA, but noted that some buprenorphine prescribers do not accept insurance. Variation in state Medicaid policy may further limit the ACA’s impact on buprenorphine access. Quantitative findings indicated the average state had 82.5 buprenorphine physicians per 1 million residents, but there were large differences between Northeastern states and those in the South, Midwest, and West. States expanding Medicaid had significantly more buprenorphine physicians (mean=99.2) than states declining the expansion (mean=65.2; p=.02), while those establishing state health insurance exchanges had more physicians (mean=114.2) than states defaulting to the federal exchange (mean=67.2; p=.009). Conclusions: The ACA’s impact on buprenorphine treatment may be uneven due to state-level and physician-level factors. Future phases of this project will continue to monitor the impact of health reform on treatment access.