Variations in US county-level trends in buprenorphine use, 2018-2022.

Abstract

Despite multiple interventions, national-level trends of buprenorphine prescription use plateaued during a period of increasing opioid overdose deaths in the United States; county-level use trends may provide additional insights. We aimed to analyze county-level trends in buprenorphine treatment for opioid use disorder (OUD) and determine factors associated with trends. In this retrospective study, we used an iterative hierarchical cluster analysis to group counties with similar buprenorphine prescription use trends and then compared characteristics between clusters. Retail pharmacy dispensing in the United States from 2018 to 2022. Data on prescriptions dispensed for buprenorphine medications labeled to treat OUD. We analyzed standardized mean differences (SMD) and 95% confidence intervals (CI) of county-level characteristics between counties with varying trends in buprenorphine utilization. Prescriptions dispensed for buprenorphine significantly increased in 924 counties (28% of US population) from 2018 to 2022 but declined in 839 counties (50%) from 2021 to 2022. Counties with decreasing (versus increasing) use had significantly higher opioid overdose death rates (SMD = -0.23; 95% CI = -0.34 to -0.13) and unemployment (SMD = -0.36; 95% CI = -0.46 to -0.27). Counties with increasing trends had higher percentages of residents in rural areas (SMD = 0.26; 95% CI = 0.16-0.35) and prescribing by nurse practitioners (SMD = 0.39; 95% CI = 0.29-0.48). From 2018 to 2022, buprenorphine use as treatment for opioid use disorder increased in some United States counties, notably counties with more residents living in rural areas and counties with more prescriptions written by nurse practitioners. However, declining use in other US counties suggest challenges persist in increasing access to medication for treament of opioid use disorder, hindering progress in addressing the opioid crisis.