Opiate Overdose Deaths and Waivered Buprenorphine

Providers: 2015

Martin Y. Iguchi, Ph.D.

RAND Corporation under contract to DSG, Inc.

Acknowledgements

This work was conducted by the RAND Corporation under contract to DSG, Inc.  RAND contributors include: Martin Y. Iguchi, Ph.D., Brad Stein, Ph.D., Rosanna Sharp, Ph.D., Jonathan Cantor, Ph.D., Ervant Maksabedian, Ph.D., Mark Sorbero, Lisa Kraus, and Bryce Pardo. DSG contributors include: Tom Vischi, Prentice Johnson, and Sam Kumar. 

Where are Buprenorphine Providers Located?

Where are Methadone Clinics Located?

What States Appear to Require One or More Waivered Providers?

What States Appear to Require More Waivered Providers Given OD Data?

What States Appear to Require More Waivered Providers Given OD Data?: North Carolina (1-tie)

What States Appear to Require More Waivered Providers Given OD Data?: Kentucky (1-tie)

What States Appear to Require More Waivered Providers Given OD Data?: Ohio (3)

What States Appear to Require More Waivered Providers Given OD Data?: West Virginia (4)

What States Appear to Require More Waivered Providers Given OD Data?: Tennessee (5)

Additional States and Higher OD-Risk Counties

IllinoisTazewellMadisonBond

VirginiaBuchananHighland

South CarolinaAikenDorchester

NevadaNyeStorey

UtahRichDaggett

OklahomaMayesPushmataha

WisconsinWashingtonKenosha

TexasNacogdochesRefugio

AlaskaHoonah‐Angoon

ArkansasBenton

ColoradoSedgwick

IndianaBlackford

South DakotaMarshall

KansasClark

New MexicoQuay

MarylandSt. Mary’s

MissouriJefferson

IowaLinn

WyomingFremont

Observations• Our focus is on provider distributions and the relationship of 

theoretical capacity to overdose deaths reported in 2015• Preponderance of rural counties have no provider capacity.• We present OD/Provider capacity – but this may not be the 

key factor driving ODs in a given county.  Massachusetts is a prime example – as provider capacity is high, yet the OD numbers are also very high.

Caveats re this Analysis• Provider data represents a theoretical capacity.• A large portion of providers do not make use of their waiver• Many see far fewer patients than allowed

• OD data last available (2015) – but patterns of OD may shift• OD data quality varies considerably by state• Naloxone programs not included (impacts fatal ODs)

Potential Next Steps (1)• Additional data layers might include:

• Prescription drug data

• Medicaid expansion states (increased access to treatment)

• States implementing hub and spoke treatment models or unique financing models

• Prescription drug monitoring programs

• Naloxone distribution locations

• There is a great need for a survey of providers to examine actual treatment impact versus theoretical capacity

• In tandem with state policy and finance models – would allow for an understanding of impacts on provider behavior

Potential Next Steps (2)• Another possibility is a national (on line) real time survey of 

waivered provider patient loads, observations, and practices – much like the American Psychological Association’s (APA) real‐time survey developed to collect practice behaviors related to substance abuse with funding from SAMHSA/CSAT.• RAND investigator Iguchi developed the real time survey 

concept and methodology for APA

• Perhaps a CTN study randomizing BUP providers in rural settings to a study utilizing mobile devices to deliver a contingency management or CBT intervention?

Thank You

For More Information:

Contact

Martin Y. Iguchi, Ph.D.

RAND Corporation 

iguchi@rand.org