Journal of substance use and addiction treatment · 2025
Gaps in buprenorphine access: Examining provider availability and treatment continuity.
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Sadeghi Abolfazl, Thornton J Douglas, Varisco Tyler J
Аннотация
BACKGROUND: Buprenorphine is a cornerstone treatment for opioid use disorder (OUD), but provider disruptions can lead to gaps in care. We hypothesize that loss of access to a patient's primary buprenorphine provider, defined as at least a 90-day gap or a permanent stop in buprenorphine prescribing, contributes to a higher risk of treatment discontinuation.
METHODS: Using a retrospective cohort design, we analyzed Texas Prescription Monitoring Program data (February 1, 2018-February 1, 2021). Patients were included if they had received buprenorphine from a single prescriber who then ceased prescribing for ≥90 days. We excluded patients receiving prescriptions from multiple providers in the 90-day lookback. Re-establishing care (≥1 new prescription from a different provider within 90 days) was the primary outcome. Logistic regression was used to identify factors associated with reinitiation of buprenorphine pharmacotherapy.
RESULTS: Of the 1083 patients analyzed, 24 % did not re-establish care following a disruption in provider availability. Rural residence significantly lowered the odds of treatment resumption (aOR = 0.60, p < 0.05), while higher doses (>8 mg/day) and longer treatment episodes prior to prescriber cessation (>60 days) increased continuity (aOR = 1.70, p < 0.05; aOR = 3.29, p < 0.05).
CONCLUSIONS: One in four patients experienced an interruption in buprenorphine care after their primary provider stopped prescribing buprenorphine, with rural patients particularly affected. Telehealth and other policy measures could mitigate these disruptions, ensuring more consistent OUD treatment. Further research is needed to understand provider- and patient-level factors contributing to these outcomes.
METHODS: Using a retrospective cohort design, we analyzed Texas Prescription Monitoring Program data (February 1, 2018-February 1, 2021). Patients were included if they had received buprenorphine from a single prescriber who then ceased prescribing for ≥90 days. We excluded patients receiving prescriptions from multiple providers in the 90-day lookback. Re-establishing care (≥1 new prescription from a different provider within 90 days) was the primary outcome. Logistic regression was used to identify factors associated with reinitiation of buprenorphine pharmacotherapy.
RESULTS: Of the 1083 patients analyzed, 24 % did not re-establish care following a disruption in provider availability. Rural residence significantly lowered the odds of treatment resumption (aOR = 0.60, p < 0.05), while higher doses (>8 mg/day) and longer treatment episodes prior to prescriber cessation (>60 days) increased continuity (aOR = 1.70, p < 0.05; aOR = 3.29, p < 0.05).
CONCLUSIONS: One in four patients experienced an interruption in buprenorphine care after their primary provider stopped prescribing buprenorphine, with rural patients particularly affected. Telehealth and other policy measures could mitigate these disruptions, ensuring more consistent OUD treatment. Further research is needed to understand provider- and patient-level factors contributing to these outcomes.