Prescriptions for Buprenorphine in Michigan Following an Education Intervention.

Chen L, Sethi S, Poland C, Frank C, Tengelitsch E, Goldstick J, Sussman JB, Bohnert ASB, Lin LA. Prescriptions for Buprenorphine in Michigan Following an Education Intervention. JAMA Network Open. 2023 Dec 1; 6(12):e2349103.

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• CDA 18-008 – Using telehealth to expand treatment access for Veterans with opioid use disorder

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Abstract:

IMPORTANCE: Buprenorphine is an underused treatment for opioid use disorder (OUD) that can be prescribed in general medical settings. Founded in 2017, the Michigan Opioid Collaborative (MOC) is an outreach and educational program that aims to address clinician and community barriers to buprenorphine access; however, the association between the MOC and buprenorphine treatment is unknown. OBJECTIVE: To evaluate the association between MOC service use and county-level temporal trends of density of buprenorphine prescribers and patients receiving buprenorphine. DESIGN, SETTING, AND PARTICIPANTS: This cohort study exploited staggered implementation of MOC services across all Michigan counties. Difference-in-difference analyses were conducted by applying linear fixed-effects regression across all counties to estimate the overall association of MOC engagement with outcomes and linear regression for each MOC-engaged county separately to infer county-specific results using data from May 2015 to August 2020. Analyses were conducted from September 2021 to November 2023. EXPOSURES: MOC engagement. MAIN OUTCOMES AND MEASURES: County-level monthly numbers of buprenorphine prescribers and patients receiving buprenorphine (per 100?000 population). RESULTS: Among 83 total counties, 57 counties (68.7%) in Michigan were engaged by MOC by 2020, with 3 (3.6%) initiating engagement in 2017, 19 (22.9%) in 2018, 27 (32.5%) in 2019, and 8 (9.6%) in 2020. Michigan is made up of 83 counties with a total population size of 9?990?000. A total of 5?070?000 (50.8%) were female, 1?410?000 (14.1%) were African American or Black, 530?000 (5.3%) were Hispanic or Latino, and 7?470?000 (74.7%) were non-Hispanic White. The mean (SD) value of median age across counties was 44.8 (6.4). The monthly increases in buprenorphine prescriber numbers in the preengagement (including all time points for nonengaged counties) and postengagement periods were 0.07 and 0.39 per 100?000 population, respectively, with the absolute difference being 0.33 (95% CI, 0.12-0.53) prescribers per 100 000 population (P? = .002). The numbers of patients receiving buprenorphine increased by an average of 0.6 and 7.15 per 100?000 population per month in preengagement and postengagement periods, respectively, indicating an estimated additional 6.56 (95% CI, 2.09-11.02) patients receiving buprenorphine per 100 000 population (P? = .004) monthly increase after engagement compared with before. CONCLUSIONS AND RELEVANCE: In this cohort study measuring buprenorphine prescriptions in Michigan over time, counties'' engagement in OUD-focused outreach and clinician education services delivered by a multidisciplinary team was associated with a temporal increase in buprenorphine prescribers and patients receiving buprenorphine.