US trends in the supply of providers with a waiver to prescribe buprenorphine for opioid use disorder in 2016 and 2018

Background: Healthcare providers can receive waivers to prescribe buprenorphine for opioid use disorder, an evidence-based medication. The United States federal government has undertaken numerous recent efforts to expand access to waivers. This study describes national trends in the U.S. in 2016 and 2018, geospatial characteristics of waivered providers, and the association of county characteristics with patient treatment capacity. Methods: Administrative data were drawn for all U.S. counties in 2016 and 2018 for waivered providers, as well as characteristics of counties that may indicate disparities in provider availability. Descriptive statistics were estimated to identify changes across the two years, and how community characteristics correlated with treatment capacity. Measures of geospatial heterogeneity were used to identify spatial clustering. Results: Nationally the number of waivered providers increased by 175% between 2016 and 2018, and patient capacity increased by 211%. In 2018, 65% of counties had at least one provider, an increase from 54.9% in 2016. Rural counties continued to have relatively fewer providers than metropolitan counties. In both years, counties with higher indicators of the opioid crisis had greater treatment capacity on average. Certain disparities continued to persist in 2018 in terms of patient capacity, as counties in metropolitan areas, those with lower poverty rates and those more physicians per capita had higher capacity on average. Conclusions: The availability of waivered providers to prescribe buprenorphine increased from 2016 to 2018, while disparities persisted. More research is needed to understand how changes in availability of waivered prescribers impact population health.