BACKGROUND: As opiate overdose deaths continue to rise in Maryland, there is an increased need for accessible treatment such as office-based buprenorphine prescribing. To date, it has been difficult for many states to characterize the extent and distribution of buprenorphine prescribing for opioid use disorder (OUD). The Maryland Prescription Drug Monitoring Program (PDMP) presents a resource for improving estimates of the prevalence of buprenorphine prescribing in Maryland by providing records of buprenorphine dispensed in the state of Maryland. This study had two aims: to determine the number of buprenorphine prescriptions dispensed in Maryland and to examine the distribution of buprenorphine prescribers in the state.
METHODS: We coded all buprenorphine-containing drugs approved by the FDA as either for pain or for OUD treatment based on their indication. We then analyzed data from the Maryland PDMP over the period from January 1 to October 15, 2016 to generate descriptive statistics for buprenorphine usage by county. We also linked the PDMP data to the DEA’s Registrant File from October 15, 2016, to assess the waiver status and location of those practitioners who prescribed buprenorphine dispensed in Maryland during this time period.
RESULTS: From January 1 to October 15, 2016, there were 220,686 buprenorphine prescriptions dispensed in Maryland, 97% indicated for OUD treatment. Nearly a quarter (24.36%) of buprenorphine prescriptions for OUD treatment were dispensed to Baltimore City residents, and another 27.2% of prescriptions were to residents of neighboring Baltimore and Anne Arundel counties. There were 1957 distinct practitioners responsible for all buprenorphine prescribing captured in the PDMP, and approximately 23% were located out-of-state. Of all practitioners who prescribed from a Maryland location, 1029 (4.49%) held a DATA waiver, and 636 (61.81%) of those wrote at least one prescription within the study time frame for any indication. Practitioners capped at 275 patients had highest waiver utilization (97.5%) while 47.99% of those capped at 30 patients prescribed buprenorphine at least once.
CONCLUSIONS: Only a small percentage of Maryland-based practitioners hold a DATA waiver, and those who do may not be utilizing their waiver to its full capacity. Most buprenorphine prescribing occurs for residents within Central Maryland, where the majority of buprenorphine prescribers are located. More encouragement and incentivization of waiver attainment in other parts of the state will ensure that all Marylanders can access buprenorphine when needed. PDMP data can serve as a tool to assist public health interventions aimed at increasing access to buprenorphine for OUD.