Examining Removal of Federal Waiver Restrictions to Prescribing Buprenorphine in Primary Care.

Abstract

Buprenorphine reduces the mortality associated with opioid use disorder (OUD) and may be prescribed in primary care. In January 2023, the requirement for a federal waiver to prescribe buprenorphine for OUD was removed. This study examines the impact of the waiver removal on buprenorphine prescribing in primary care. This retrospective cohort study used electronic health record data from 32 primary care clinics in Washington and Idaho. The sample included all patients 18 or older who had a primary care visit between January 2022 and December 2023. We described the number of patients who received buprenorphine in the year prior and the year following the removal of the waiver. We used generalized estimating equations with exchangeable correlation structure to estimate the odds ratio of receiving buprenorphine after the removal of the federal waiver. A total of 56,003 patients met inclusion criteria and were included in the sample. The overall sample was 58.9% female, 75.8% White and mean age was 49.3 years. During the 2-year study period, 986 (1.8%) patients received buprenorphine. In our sample, we did not find a significant change in buprenorphine prescribing the year after the removal of the federal waiver after adjusting for sociodemographic characteristics (<i>OR </i>=<i> </i>1.08, 95% <i>CI</i> 0.98-1.20). No significant interactions were found between the time period relative to the federal waiver removal and sociodemographic characteristics. Buprenorphine prescribing did not increase the year after the removal of the federal waiver, suggesting this regulatory change was insufficient to increase buprenorphine prescribing in primary care.