141st APHA Annual Meeting and Exposition

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290933
Auditing access to office-based therapy for opioid addiction in Massachusetts


Monday, November 4, 2013

Lello Tesema, MD, Cambridge Health Alliance, Cambridge, MA
Genevieve Bergeron, MD, Cambridge Health Alliance, Cambridge, MA
James Yeh, MD, Cambridge Health Alliance, Cambridge, MA
Michael Soliman, MD, Cambridge Health Alliance, Cambridge, MA
Rachel Hathaway, MD, Cambridge Health Alliance, Cambridge, MA
Christina Pham, MD, Cambridge Health Alliance, Cambridge, MA
Jeffrey Marshall, MD, Cambridge Health Alliance, Cambridge, MA
Danny McCormick, MD, Cambridge Health Alliance, Cambridge, MA
Background: Opioid addiction is a rising public health threat, yet substantial barriers limit access to pharmacologic treatment. While both methadone and buprenorphine are gold-standard treatments for opioid dependence, buprenorphine can be prescribed by office-based providers, thus potentially expanding access. However, little is known about the availability of treatment with buprenorphine in office-based settings.

Methods: We compiled a comprehensive list of phone numbers for individual physicians and clinics licensed to prescribe buprenorphine in Massachusetts using the Substance Abuse and Mental Health Services Administration Physician and Treatment Program Locator and online buprenorphine physician directories. Using a standardized script, we called each provider posing as a new patient seeking an appointment for buprenorphine treatment; for each provider we ascertained appointment availability using private insurance and Medicaid. If insurance was declined, an attempt was made to get an appointment with a cash payment.

Results: For 447 identified providers, calls made using private insurance, 362 (81.0%) were unsuccessful in obtaining an appointment; 48 (10.7%) accepted private insurance, and an additional 37 (8.3%) accepted cash only. For 446 identified providers, calls made offering Medicaid, 364 (81.6%) were unsuccessful in obtaining an appointment; 41 (9.2%) accepted Medicaid and an additional 41 (9.2%) accepted cash only. Approximately half of all successful appointments required cash only payment.

Conclusion: Only a small number and proportion of buprenorphine prescribers in Massachusetts accepted new patients seeking treatment with buprenorphine. Policies designed to expand access to office-based therapy with buprenorphine have the potential to decrease the public health burden of opioid addiction.

Learning Areas:

Advocacy for health and health education

Learning Objectives:
Assess access to office-based opioid addiction treatment with buprenorphine in the state of Massachuseets

Keyword(s): Access to Health Care, Other Drugs

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been principally responsible in the design, implementation and analysis of this study.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3395.0: Substance Abuse Treatment Programs New Approaches and Best Practices to Improve Outcomes