States' implementation of the Affordable Care Act and the supply of physicians waivered to prescribe buprenorphine for opioid dependence

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29 Scopus citations


Background: Although the Affordable Care Act (ACA) is anticipated to affect substance use disorder (SUD) treatment, its impact on the supply of physicians waivered to treat opioid dependence with buprenorphine has not been considered. This study examined whether states more supportive of ACA, meaning those that had opted to expand Medicaid and establish a state-based health insurance exchange, experienced greater growth in physician supply than less supportive states. Methods: Buprenorphine physician supply, including total physician supply, supply of 30-patient physicians, and supply of 100-patient physicians per 100,000 state residents, was measured from June 2013 to May 2015. State characteristics were drawn from multiple secondary sources, with states categorized as ACA-supportive, ACA-hybrid (where states either expanded Medicaid or established a state-based exchange), or ACA-resistant (where states took neither action). Mixed effects regression was used to estimate state-level growth curves to test whether rates of growth varied by states' approaches to implementing ACA. Results: The supply of waivered physicians grew significantly over the two-year period. Rates of growth were significantly lower in ACA-hybrid and ACA-resistant states relative to growth in ACA-supportive states. Average buprenorphine physician supply at baseline varied by region, the percentage of residents covered by Medicaid, and the supply of specialty SUD treatment programs. Conclusions: This study found a positive impact of the ACA on growth in the supply of buprenorphine-waivered physicians in US states. Future research should address whether the ACA affects the number of patients receiving buprenorphine, Medicaid spending, and the quality of treatment services delivered.

Original languageEnglish
Pages (from-to)36-43
Number of pages8
JournalDrug and Alcohol Dependence
StatePublished - 2015

Bibliographical note

Funding Information:
Funding for this study was provided by the National Institute on Drug Abuse (NIDA Grant R33DA035641 ), an institute within the National Institutes of Health (NIH). NIDA had no further role in study design; in the collection, analysis or interpretation of data; the writing of this manuscript; or the decision to submit it for publication. The authors are solely responsibility for this content, which does not represent the official views of the NIH or NIDA.

Funding Information:
H. Knudsen has no conflicts of interest. M. Lofwall has consulted for Orexo and CVS Caremark, received contract research funding from Braeburn Pharmaceuticals, and received honoraria from PCM Scientific, who receives unrestricted educational grant funds from Reckitt Benckiser, for developing and giving educational talks on opioid dependence. Dr. Havens has received honoraria from Pinney Associates for serving on an external advisory board examining abuse and diversion of generic buprenorphine. S. Walsh has received research support for a project sponsored by Braeburn Pharmaceuticals, consulting fees from Camurus and Braeburn Pharmaceuticals, and honoraria from PCM Scientific through an arms-length unrestricted educational grant from Reckitt Benckiser as a speaker and organizer of conferences.

Publisher Copyright:
© 2015 Elsevier Ireland Ltd.


  • Affordable Care Act
  • Buprenorphine
  • Health insurance exchanges
  • Medicaid expansion
  • Physician supply

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)


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