New research from Avalere Health evaluates states' opioid treatment capacity by measuring buprenorphine prescriber numbers against the seriousness of each state's overdose crisis. By that measure, the most serious provider shortage areas largely cut a swath across the nation's Mid-Atlantic and Midwest regions, found the study from the data-driven consulting firm.
The 11 states with ratios of prescribers to overdose deaths that are significantly lower than the national average are Illinois, Iowa, Maryland, Michigan, Missouri, New Hampshire, North Carolina, Ohio, Virginia, West Virginia and Wisconsin, the study reported.
Clara Soh, a director at Avalere, tells Addiction Professional that while past analyses of opioid treatment capacity have explored an urban/rural divide, there has not been as much evaluation of state-by-state differences.
“We wanted to look at capacity to see if it's responsive to the level of the epidemic in each state,” says Soh. Overdose deaths serve as the most quantifiable measure of the magnitude of each state's opioid crisis, she says.
The analysis yields some compelling findings. For example, New Hampshire fares comparatively poorly in prescriber capacity, while neighboring Vermont is one of the more provider-rich states, thanks in part to the state government's implementation of a “hub and spoke” model that connects centralized opioid treatment programs to office-based buprenorphine practices across the state.
Soh adds that it is also important to look at state-level comparisons because while federal policy has dictated changes such as capacity expansion through allowing physician extenders to prescribe buprenorphine, scope-of-practice requirements in the states often prove to have a greater effect on actual access to treatment.
Besides the 11 states with the greatest capacity concerns, other states falling below the national average of prescriber per overdose are Arizona, Kentucky, Minnesota, Nevada, Oklahoma, South Carolina, South Dakota, Tennessee and Utah.
This research did not factor into the analysis the availability of methadone treatment in each state.
Soh emphasizes that it is beyond the reach of this analysis to draw broad conclusions about the appropriateness of specific state-level approaches to combating opioid addiction and overdose deaths.
“This is fundamentally a very complex topic,” she says. “It's not just about throwing doctors at it.”
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