Publications · 2019
Access to office-based buprenorphine treatment in areas with high opioid-related mortality: an audit study
Annals of Internal Medicine , 2019 · doi:10.7326/M18-3457
Overview
Posing as uninsured or Medicaid-covered patients reporting active heroin use, we made 1,092 calls to 546 buprenorphine prescribers across six high-mortality jurisdictions. About half of Medicaid contacts were offered any new appointment, but only 27% were offered one with the possibility of starting buprenorphine at the first visit. Wait times when appointments were offered were short (median 6 days), suggesting existing prescribers may have additional capacity that current screening practices do not reach.
Abstract
BACKGROUND: Improving access to treatment for opioid use disorder is a national priority, but little is known about the barriers encountered by patients seeking buprenorphine-naloxone ("buprenorphine") treatment. OBJECTIVE: To assess real-world access to buprenorphine treatment for uninsured or Medicaid-covered patients reporting current heroin use. DESIGN: Audit survey ("secret shopper" study). SETTING: 6 U.S. jurisdictions with a high burden of opioid-related mortality (Massachusetts, Maryland, New Hampshire, West Virginia, Ohio, and the District of Columbia). PARTICIPANTS: From July to November 2018, callers contacted 546 publicly listed buprenorphine prescribers twice, posing as uninsured or Medicaid-covered patients seeking buprenorphine treatment. MEASUREMENTS: Rates of new appointments offered, whether buprenorphine prescription was possible at the first visit, and wait times. RESULTS: Among 1092 contacts with 546 clinicians, schedulers were reached for 849 calls (78% response rate). Clinicians offered new appointments to 54% of Medicaid contacts and 62% of uninsured-self-pay contacts, whereas 27% of Medicaid and 41% of uninsured-self-pay contacts were offered an appointment with the possibility of buprenorphine prescription at the first visit. The median wait time to the first appointment was 6 days (interquartile range [IQR], 2 to 10 days) for Medicaid contacts and 5 days (IQR, 1 to 9 days) for uninsured-self-pay contacts. These wait times were similar regardless of clinician type or payer status. The median wait time from first contact to possible buprenorphine induction was 8 days (IQR, 4 to 15 days) for Medicaid and 7 days (IQR, 3 to 14 days) for uninsured-self-pay contacts. LIMITATION: The survey sample included only publicly listed buprenorphine prescribers. CONCLUSION: Many buprenorphine prescribers did not offer new appointments or rapid buprenorphine access to callers reporting active heroin use, particularly those with Medicaid coverage. Nevertheless, wait times were not long, implying that opportunities may exist to increase access by using the existing prescriber workforce. PRIMARY FUNDING SOURCE: National Institute on Drug Abuse.
Recognition & impact
Awards3
- Best of 2019 (Editor-selected, top 10 of the year)Annals of Internal Medicine
- Highest Impact Publications (2019-2020)American Society of Addiction Medicine
- Best of Annual Research Meeting (Behavioral Health Theme, 2019)AcademyHealth Annual Research Meeting
Cited in policy & guidance2
- Access to Treatment for Opioid Use DisorderThe Oxford Handbook of Opioids and Opioid Use Disorder
- Report to Congress: Utilization Management of Medication-Assisted Treatment in Medicaid (October 2019)Medicaid and CHIP Payment and Access Commission (MACPAC)
Media8
- Study: Heroin users in Ohio face barriers to addiction treatmentNPR (WOSU): Morning Edition
- Researchers pose as heroin users to find treatment gapsAssociated Press
- Secret shopper hospitalNew York Times
- In states with most overdose deaths, poor patients struggle to find treatmentReuters
- Patients WHO want to use Suboxone for addiction can have trouble getting it, study findsNPR (WBUR)
- Access to office-based buprenorphine treatment in areas with high rates of opioid-related mortality: An audit studyRAND Policy Brief
- Many buprenorphine prescribers not offering new appointmentsHealthDay
- America's response to addiction relies on fixing this websiteCNN News
Editorial1
- Role of an Accurate Treatment Locator and Cash-Only Practices in Access to Buprenorphine for Opioid Use Disorders. Annals of Internal Medicine. 2019;171(1):58-59.
Topics
- buprenorphine
- opioid use disorder
- audit study
- secret shopper
- Medicaid
- access to care
- DATA Waiver
- health policy
How to cite
Beetham T, Saloner B, Wakeman SE, Gaye M, Barnett M. Access to office-based buprenorphine treatment in areas with high opioid-related mortality: an audit study. Annals of Internal Medicine; 2019. doi:10.7326/M18-3457
Show BibTeX
@article{beetham2019accessto,
title = {{Access to office-based buprenorphine treatment in areas with high opioid-related mortality: an audit study}},
author = {Beetham, T. and Saloner, B. and Wakeman, S. E. and Gaye, M. and Barnett, M.},
journal = {Annals of Internal Medicine},
year = {2019},
doi = {10.7326/M18-3457},
url = {https://doi.org/10.7326/M18-3457},
abstract = {BACKGROUND: Improving access to treatment for opioid use disorder is a national priority, but little is known about the barriers encountered by patients seeking buprenorphine-naloxone ("buprenorphine") treatment. OBJECTIVE: To assess real-world access to buprenorphine treatment for uninsured or Medicaid-covered patients reporting current heroin use. DESIGN: Audit survey ("secret shopper" study). SETTING: 6 U.S. jurisdictions with a high burden of opioid-related mortality (Massachusetts, Maryland, New Hampshire, West Virginia, Ohio, and the District of Columbia). PARTICIPANTS: From July to November 2018, callers contacted 546 publicly listed buprenorphine prescribers twice, posing as uninsured or Medicaid-covered patients seeking buprenorphine treatment. MEASUREMENTS: Rates of new appointments offered, whether buprenorphine prescription was possible at the first visit, and wait times. RESULTS: Among 1092 contacts with 546 clinicians, schedulers were reached for 849 calls (78% response rate). Clinicians offered new appointments to 54% of Medicaid contacts and 62% of uninsured-self-pay contacts, whereas 27% of Medicaid and 41% of uninsured-self-pay contacts were offered an appointment with the possibility of buprenorphine prescription at the first visit. The median wait time to the first appointment was 6 days (interquartile range [IQR], 2 to 10 days) for Medicaid contacts and 5 days (IQR, 1 to 9 days) for uninsured-self-pay contacts. These wait times were similar regardless of clinician type or payer status. The median wait time from first contact to possible buprenorphine induction was 8 days (IQR, 4 to 15 days) for Medicaid and 7 days (IQR, 3 to 14 days) for uninsured-self-pay contacts. LIMITATION: The survey sample included only publicly listed buprenorphine prescribers. CONCLUSION: Many buprenorphine prescribers did not offer new appointments or rapid buprenorphine access to callers reporting active heroin use, particularly those with Medicaid coverage. Nevertheless, wait times were not long, implying that opportunities may exist to increase access by using the existing prescriber workforce. PRIMARY FUNDING SOURCE: National Institute on Drug Abuse.},
keywords = {buprenorphine; opioid use disorder; audit study; secret shopper; Medicaid; access to care; DATA Waiver; health policy},
note = {Awards: Best of 2019 (Editor-selected, top 10 of the year), Annals of Internal Medicine; Highest Impact Publications (2019-2020), American Society of Addiction Medicine; Best of Annual Research Meeting (Behavioral Health Theme, 2019), AcademyHealth Annual Research Meeting. Media coverage: NPR (WOSU): Morning Edition, Associated Press, New York Times, Reuters. Editorial: Lagisetty PA, Bohnert A. Role of an Accurate Treatment Locator and Cash-Only Practices in Access to Buprenorphine for Opioid Use Disorders. Annals of Internal Medicine. 2019;171(1):58-59.}
}