Tracking the geographic distribution and growth of clinicians with a DEA waiver to prescribe buprenorphine to treat opioid use disorder.

Purpose: Buprenorphine is an effective medication treatment for opioid use disorder (MOUD) but access is difficult for patients, especially in rural locations. To improve access, legislation, including the Comprehensive Addiction and Recovery Act (2016) and the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act (2018), extended the ability to get a Drug Enforcement Administration (DEA) waiver to prescribe buprenorphine to treat opioid use disorder (OUD) to numerous types of clinicians. This study updates the distribution of waivered clinicians as of July 2020 and notes regional and geographic differences.

Methods: Using the July 2020 Drug Enforcement Administration list of providers with a waiver to prescribe buprenorphine to treat OUD, we assigned waivered clinicians to counties in one of four geographic categories. We calculated the number of counties in each category that did not have a waivered clinician, available treatment slots, and the county provider to population ratios.

Findings: The number of DEA-waivered clinicians more than doubled between December 2017 and July 2020 from 37,869 to 98,344. The availability of a clinician with a DEA waiver to provide MOUD has increased across all geographic categories. Nearly two-thirds of all rural counties (63.1%) had at least one clinician with a DEA waiver but more than half of small and remote rural counties lacked one. There were also significant differences in access by the US Census Division.

Conclusions: Overall, MOUD access has improved, but small rural communities still experience treatment disparities and there is significant regional variation.