Buprenorphine Dispensing after Elimination of the Waiver Requirement

Abstract

the U.S. government eliminated the requirement for a waiver from the Drug Enforcement Administration (DEA) to prescribe buprenorphine. 1 Buprenorphine is considered to be underused for opioid use disorder and has been shown to reduce the risk of fatal overdose. 2,3The elimination of this waiver was intended to lower barriers to buprenorphine prescribing and potentially expand the pool of prescribers, which might increase buprenorphine dispensing and the initiation of treatment.We evaluated the changes in buprenorphine prescribing patterns in relation to the change in DEA policy using the IQVIA Longitudinal Prescription Database, which captures 92% of prescriptions dispensed in U.S. retail pharmacies.For each month during 2022 and 2023, we calculated the number of prescribers accounting for buprenorphine dispensing, the number of patients with buprenorphine dispensing, and the number of new patients in whom buprenorphine treatment was initiated (filling a prescription for the first time in the previous 180 days). 4Using an interrupted-time-series design, 5 we assessed whether these outcomes changed in January 2023 in comparison to the change expected from trends before policy implementation ("level change").We also assessed whether the monthly rate of change in outcomes increased or decreased after January 2023 ("slope change").The Supplementary Appendix, available with full text of this letter at NEJM.org, includes additional details.Between January and December 2022, the monthly number of buprenorphine prescribers increased from 38,684 to 42,158.In January 2023, there was a level increase of 1938 prescribers (95% confidence interval [CI], 990 to 2887) and a slope increase of 595 prescribers per month (95% CI, 393 to 786) (Fig. 1A).In December 2023, there were 53,635 buprenorphine prescribers.

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