The study analyzes the effects of state-level policies on the use of anti-opioid drugs

States that want to increase access to buprenorphine, a life-saving drug used to treat opioid use disorder, should consider efforts to improve professional education and clinical knowledge, according to a new RAND Corporation study.

Examining six state-level policies aimed at increasing buprenorphine use, the researchers found that requiring buprenorphine prescribers to receive additional education beyond the initially required education, as well as continuing medical education related to substance abuse , were both associated with a significant increase in use of buprenorphine treatment.

The results are published in the latest issue of the journal JAMA Health Forum.

“Many studies suggest that physicians and other health care professionals are concerned about whether they have enough knowledge about using buprenorphine to treat opioid use disorder,” said Bradley D. Stein, lead author of the study and a medical scientist at RAND, a non-profit research organization. “We’ve found that requiring additional continuing education appears to help address this concern, enabling them to make greater use of their training.”

The study analyzed the effects of six different state-level policies: rules requiring additional education for buprenorphine prescribers beyond the initial training required for exemption from X; continuing medical education related to substance abuse and addiction; extending Medicaid coverage to buprenorphine treatment; expand Medicaid coverage in general; require prescribers to use prescription drug monitoring programs; and regulate pain management clinics.

The number of fatal opioid overdoses in the United States continues to rise, and an estimated 5.6 million people in the nation have opioid use disorder. Drug treatment for opioid use disorder is considered the standard of care, improving quality of life and decreasing rates of fatal overdose.

The new study used registries that capture 90 percent of prescriptions filled at U.S. retail pharmacies, identifying buprenorphine prescriptions filled between 2006 and 2018. The researchers used a variety of sources to identify when states implemented one of the six policies under consideration.

The researchers analyzed records to identify new episodes of buprenorphine treatment for opioid use disorder by comparing trends in drug use with when states adopted the various policies. The results were compiled at the county level, controlling for local characteristics that may influence buprenorphine prescribing.

During the study period, nationwide use of buprenorphine increased dramatically, the researchers found. The number of months of buprenorphine treatment per 1,000 people increased from 1.5 in 2006 to 22.8 in 2018.

The data showed that during this period, the demand for buprenorphine prescriber education beyond the initial training required for a waiver was associated with a significant increase in the number of months of buprenorphine treatment per person in the year following implementation of such a policy.

Under these regulations, buprenorphine use increased by approximately 9 months of treatment per 1,000 people in the first year, rising to more than 14 months of treatment per 1,000 people in the fifth year after implementation.

The requirement for continuing medical education related to substance abuse or addiction for medical licensure has also been associated with increases. Under those rules, buprenorphine use increased by about 7 months of treatment per 1,000 people in the first year, rising to more than 11 months of treatment per 1,000 people in the fifth year.

The study found that prescription drug monitoring programs, pain management clinic laws, and Medicaid policies had no association with buprenorphine dispensing.

“Our findings suggest that requiring education for buprenorphine prescribers and substance use disorder treatment training for healthcare professionals are viable propositions for increasing buprenorphine utilization and ultimately serving more patients.” said Stein, who is director of the RAND-USC Schaeffer Opioid Policy Tools and Information Center. “The potential benefits of training in the treatment of patients with substance use disorders are especially important given the requirement for such training for most prescribers in the recently passed Federal Consolidated Appropriations Act.”

Support for the study was provided by the Foundation for Opioid Response Efforts and the National Institute on Drug Abuse of the National Institutes of Health under approval numbers P50DA046351, R01DA048500 and K01DA042139. The content presented in this release is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Other study authors are Brendan K. Saloner of the Johns Hopkins Bloomberg School of Public Health; Olivia K. Golan of the Georgia State University School of Public Health; Barbara Andraka-Christou of the University of Central Florida; Christina Andrews of the Arnold School of Public Health at the University of South Carolina; Andrew W. Dick and Flora Sheng, both of RAND Corporation; Corey S. Davis of the Network for Public Health Law; and Adam J. Gordon of the VA Salt Lake City Health Care System.

RAND Health Care promotes healthier societies by improving health care systems in the United States and beyond.