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Opiate Overdose Deaths and Waivered Buprenorphine
Providers: 2015
Martin Y. Iguchi, Ph.D.
RAND Corporation under contract to DSG, Inc.
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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.
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Where are Buprenorphine Providers Located?
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Where are Methadone Clinics Located?
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What States Appear to Require One or More Waivered Providers?
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What States Appear to Require More Waivered Providers Given OD Data?
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What States Appear to Require More Waivered Providers Given OD Data?: North Carolina (1-tie)
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What States Appear to Require More Waivered Providers Given OD Data?: Kentucky (1-tie)
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What States Appear to Require More Waivered Providers Given OD Data?: Ohio (3)
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What States Appear to Require More Waivered Providers Given OD Data?: West Virginia (4)
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What States Appear to Require More Waivered Providers Given OD Data?: Tennessee (5)
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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
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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.
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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)
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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
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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?