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

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.