Assessing buprenorphine treatment utilization and SAMHSA DATA waiver provider distribution in 2021: a real-world analysis in California

Qualified clinicians previously required a practitioner waiver (i.e., "DATA-waiver" or "X-waiver") to offer buprenorphine, a medication for opioid use disorder (OUD). However, many counties in the US experience fewer buprenorphine prescriptions due to factors such as "DATA-waiver" providers underutilizing their buprenorphine prescribing ability. Our study aimed to compare the availability of active buprenorphine-prescribing clinicians in California to the Substance Abuse and Mental Health Services Administration (SAMSHA)-listed DATA waived prescribers under each 5-digit ZIP Code. This study utilized the buprenorphine prescription record data in 2021 from California's Controlled Substance Utilization Review and Evaluation System (CURES). The list of the locators for all DATA-waiver clinicians was obtained from the SAMHSA webpage. Among 1,600 ZIP Codes where patients resided, 62.1% housed DATA-waived physicians, and 57.8% had active buprenorphine-prescribing clinicians. A disproportional distribution between buprenorphine-prescribing clinicians and DATA-waived physicians was evident. Among physicians listed in the SAMHSA roster, not all were actively prescribing buprenorphine. Significant disparities in access to active prescribers and DATA waiver prescribers persist between rural and urban areas in California. Addressing these issues requires resource allocation and inter-professional collaboration. The 2022 Omnibus bill's policy changes hold promise, necessitating further effort into OUD-based policy changes.