State Policies and Adoption of Buprenorphine
» Project Details
In recent years, there has been broad concern about effective translation of evidence-based practice from academic settings and clinical trials to community-based treatment programs. Recent U.S. Food and Drug Administration (FDA) approval of buprenorphine (a Schedule III narcotic) for the treatment of opioid dependence has given treatment providers and their patients a new and effective treatment option. But buprenorphine can only diffuse to the field in the context of federal and state policies and regulations regarding its use. In this context, there are no clear incentives, and several potential impediments, to the adoption of buprenorphine in community-based treatment programs.
This study will explore the impact of state regulations and funding policies on the adoption of buprenorphine by community-based treatment programs in the United States. The goal of the project is to document current state policies, identify statistical associations between state policies and the diffusion of buprenorphine, and identify other real-world impediments or disincentives to buprenorphine adoption in community treatment programs.
The study has three component parts. First, we will review current state policy relevant to the adoption of buprenorphine by community treatment programs, including the availability and limitations of Medicaid coverage. This activity will include a review of state regulations, publications, and available online documentation, complemented with telephone interviews with State Methadone Authorities (SMA) and other relevant state agency staff.
Second, we will create measures of various state policies (including, for example, special program licensing requirements, and listing of buprenorphine on state Medicaid formularies) and use these measures in secondary analyses of existing data from more than 1,000 community treatment programs. Organizational-level data (including current status of buprenorphine adoption) are available on nationally representative samples of public and private sector treatment programs, as well as programs affiliated with the National Institute on Drug Abuse (NIDA) Clinical Trials Network. These analyses will incorporate state policy measures as predictors of program adoption and implementation of buprenorphine as of 2005, controlling for a host of other organizational characteristics previously found to be associated with medication adoption.
Third, we will convene a focus group with treatment providers to explore unmeasured impacts and latent effects of state policies in the adoption process. The use of multiple methods and multiple sources will provide a comprehensive assessment of the role of state policies in the diffusion of this new medication for opioid addiction treatment.