Geographic location of buprenorphine-waivered physicians and integration with health systems

Efforts are underway to expand buprenorphine treatment for opioid use disorder (OUD) in hospitals and affiliated health systems, yet we do not know whether physicians who prescribe buprenorphine are likely to be health-system affiliated. Our study draws upon SK&A data covering primary care physicians and psychiatrists in eight states (California, Florida, Georgia, Maryland, Ohio, Rhode Island, Wisconsin, and West Virginia), which were linked to a list of waivered buprenorphine prescribers from the U.S. Drug Enforcement Agency. We calculated waivered rates stratified by patient limits, physician type, health system affiliation, and area-level characteristics. We mapped the spatial relationship between hospitals and waivered physicians in four metro areas. We found that primary care physicians affiliated with hospital health systems were less likely to have waivers than unaffiliated physicians (3.6% versus 8.2%), but the reverse was true for psychiatrists (33.2% versus 26.2%). Waivered physicians affiliated with health systems were less likely to practice in high-poverty areas than unaffiliated counterparts, and affiliated physicians were also more likely to cluster near hospitals. Health systems may be able to improve access to buprenorphine treatment in their communities by creating either incentives or mandates for more affiliated physicians to obtain a waiver.