Fewer than 2 percent of obstetrician-gynecologists who accept Medicaid are able to prescribe buprenorphine, according to a study published online Dec. 11 in JAMA Network Open.
Max Jordan Nguemeni Tiako, from the Yale School of Medicine in New Haven, Connecticut, and colleagues assessed the prevalence and geographic distribution of U.S. obstetrician-gynecologists who can prescribe buprenorphine (called X-waivered) in 2019. Data from 31,211 obstetrician-gynecologists identified from the Centers for Medicare & Medicaid Services Physician Compare data set were linked to the Drug Addiction Treatment Act buprenorphine-waived clinician list.
The researchers found that only 560 of the identified obstetrician-gynecologists (1.8 percent) were X-waivered. The odds of being X-waivered were higher among obstetrician-gynecologists in counties with less than 5 percent uninsured residents (adjusted odds ratio [aOR], 1.59) compared with providers in counties with greater than 15 percent uninsured residents. Obstetrician-gynecologists in suburban counties (e.g., urban population of ≥20,000 and adjacent to a metropolitan area) were more likely to be X-waivered (aOR, 1.85) compared with those in metropolitan counties. Obstetrician-gynecologists in states with a neonatal abstinence syndrome (NAS) rate of ≥15 per 1,000 births also had higher odds of being X-waivered (aOR, 4.94) compared with states with an NAS rate of five per 1,000 births or less. X-waivers were more likely among obstetrician-gynecologists without hospital privileges (aOR, 1.32).
“Results of this study suggest that an opportunity exists for obstetrician-gynecologists to contribute to expanding the workforce of clinicians who can prescribe buprenorphine to further address the opioid epidemic’s association with maternal and infant morbidity and mortality,” the authors write.