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Research ArticleOriginal Research

Geographic and Specialty Distribution of US Physicians Trained to Treat Opioid Use Disorder

Roger A. Rosenblatt, C. Holly A. Andrilla, Mary Catlin and Eric H. Larson
The Annals of Family Medicine January 2015, 13 (1) 23-26; DOI: https://doi.org/10.1370/afm.1735
Roger A. Rosenblatt
1WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
MD, MPH, MFR
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C. Holly A. Andrilla
1WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
MS
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  • For correspondence: hollya@uw.edu
Mary Catlin
1WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
2Group Health Cooperative of Puget Sound, Seattle, Washington
BSN, MPH
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Eric H. Larson
1WWAMI Rural Health Research Center, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington
PhD
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    Figure 1

    US counties with physicians with waivers to prescribe buprenorphine.

    Note: data source: Drug Enforcement Administration, July 2012. Map date: September 2013.

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    Table 1

    Supply of Physicians With DEA DATA Waivers in US Counties, by Rural-Urban Status

    MetropolitanaAdjacent to MetropolitanbMicropolitan, Not Adjacent to MetropolitancSmall and Remote Rural Countiesd
    CharacteristicUIC 1–2UIC 3–7UIC 8UIC 9–12Total
    US population, No. (%)260,479,400 (83.6)33,691,096 (10.8)9,677,339 (3.1)7,744,082 (2.4)311,591,917 (100.0)
    Counties with ≥1 physicians with waivers, No. (%)789 (72.4)419 (39.6)132 (46.8)125 (17.5)1,465 (46.6)
    Counties with no physician with a waiver, No. (%)301 (27.6)639 (60.4)150 (53.2)588 (82.5)1,678 (53.4)
    Total counties, No. (%)1,090 (34.7)1,058 (33.7)282 (9.0)713 (22.7)3,143 (100.0)
    Physicians with waivers per 100,000 residents, No.6.33.34.23.15.8
    Physicians with waivers, %90.46.12.31.3100.0
    • DATA = Drug Addiction Treatment Act; DEA = Drug Enforcement Administration; UIC = Urban Influence Code.

      Note: counties were classified as urban or into 1 of 3 categories of rural using the US Department of Agriculture UIC.

    • ↵a Counties with an urban core with a population of at least 50,000.

    • ↵b Counties that are geographically adjacent to a metropolitan area whose largest town/urban cluster has 10,000–49,999 residents.

    • ↵c Counties that are not adjacent to a metropolitan area and whose largest town/urban cluster has 10,000–49,999 residents.

    • ↵d Counties whose largest town has fewer than 10,000 residents regardless of proximity to a micropolitan county.

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  • The Article in Brief

    Geographic and Specialty Distribution of Physicians Trained to Provide Office-Based Treatment of Opioid Use Disorder in the United States

    Roger A. Rosenblatt , and colleagues

    Background The United States is experiencing an epidemic of opioid-related deaths due to excessive prescribing of opioids, misuse of prescription drugs, and increased use of heroin. Buprenorphine-naloxone is an effective treatment for opioid use disorder. It can be prescribed by office-based physicians who complete training to obtain a waiver to treat opioid use. This study examines the extent to which the US population has local access to waivered clinicians who can provide effective treatment for opioid use disorder.

    What This Study Found Only 3.6 percent of American primary care physicians have obtained the waiver required to dispense buprenorphine. Ninety percent of those physicians practice in urban counties, leaving the majority of US counties (53 percent) -- most of them rural -- with no physician who can dispense buprenorphine. Although primary care physicians are the predominant providers of health care in rural America, very low percentages of family physicians and general internists have obtained a waiver. Most US counties, therefore, have no physicians with waivers to prescribe buprenorphine-naloxone and, as a result, more than 30 million people live in counties without access to buprenorphine treatment.

    Implications

    • The low numbers of rural physicians trained to provide office-based treatment of opioid use disorder, the authors conclude, is a major barrier to office-based outpatient treatment for opioid use disorder.
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The Annals of Family Medicine: 13 (1)
The Annals of Family Medicine: 13 (1)
Vol. 13, Issue 1
January/February 2015
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Geographic and Specialty Distribution of US Physicians Trained to Treat Opioid Use Disorder
Roger A. Rosenblatt, C. Holly A. Andrilla, Mary Catlin, Eric H. Larson
The Annals of Family Medicine Jan 2015, 13 (1) 23-26; DOI: 10.1370/afm.1735

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Geographic and Specialty Distribution of US Physicians Trained to Treat Opioid Use Disorder
Roger A. Rosenblatt, C. Holly A. Andrilla, Mary Catlin, Eric H. Larson
The Annals of Family Medicine Jan 2015, 13 (1) 23-26; DOI: 10.1370/afm.1735
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