An Analysis of Patterns of Distribution of Buprenorphine in the United States using ARCOS, Medicaid, and Medicare Databases
Authors: Hsu Zhi-Shan , Warnick Justina A. , Harkins Tice R. , Sylvester Briana E. , Bharati Neal K. , Eley leTausjua B. , Nichols Stephanie D. , McCall Kenneth , Piper Brian J. 
Published: August 2022

AbstractPurposeOpioid overdose remains a problem in the United States despite pharmacotherapies, such as buprenorphine, in the treatment of opioid use disorder (OUD). This study characterized changes in buprenorphine use.MethodsUsing the Drug Enforcement Administration’s ARCOS, Medicaid and Medicare claims databases, patterns in buprenorphine usage in the United States from 2018 to 2020 were analyzed by examining percentage changes in total grams distributed and changes in grams per 100K people in year-to-year usage based on zip-code and state levels.ResultsFor ARCOS from 2018-19 and 2019-20, total buprenorphine distribution in grams increased 16.2% and 12.6% respectively. South Dakota showed the largest state-wide percentage increase in both 2018-19 (66.1%) and 2019-20 (36.7%). From 2018-19, the zip codes ND-577 (156.4%) and VA-222 (−82.1%) had the largest and smallest percentage changes respectively. From 2019-20, CA-932 (250.2%) and IL-603 (−36.8%) were the largest and smallest respectively. In both 2018-19 and 2019-20, PA-191 had the second highest increase in grams per 100K while OH-452 was the only zip code to remain in the top 3 largest decreases in grams per 100K in both periods. Among Medicaid patients in 2018, there was a 1,932.1-fold difference in prescriptions per 100k Medicaid enrollees between Kentucky (12,075.5) and Nebraska (6.25). Among Medicare enrollees in 2018, family medicine physicians and other primary care providers were the top buprenorphine prescribers.ConclusionsThis study identified overall increases in buprenorphine availability but also pronounced state-level differences. Such geographic analysis can be used to discern which public policies and regional factors impact buprenorphine access.Key PointsTotal buprenorphine distribution in grams increased 16.2% and 12.6% for 2018-2019 and 2019-2020 ARCOS data, respectivelyOn a state level, from 2020-21, the majority of states were decreasing buprenorphine distribution as reported by ARCOSThe state with the highest buprenorphine usage among Medicaid patients in both 2018 and 2019 was KentuckyFamily medicine physicians were the top buprenorphine prescribers to Medicare enrollees in 30 statesMaine had the largest number of buprenorphine prescriptions to Medicare enrolleesPlain Language SummaryOpioid overdose remains a problem in the United States despite medical therapy, such as buprenorphine, in the treatment of opioid use disorder (OUD). This study aimed to describe changes in buprenorphine use. Using the Drug Enforcement Administration’s ARCOS, Medicare, and Medicaid databases, patterns in buprenorphine usage in the United States from 2018 to 2020 were analyzed based on zip-code and state levels. For ARCOS from 2018-19 and 2019-20, total buprenorphine distribution in grams increased 16.2% and 12.6% respectively.South Dakota showed the largest state-wide percentage increase in both 2018-19 (66.1%) and 2019-20 (36.7%). From 2018-19, the zip codes ND-577 (156.4%) and VA-222 (−82.1%) had the largest and smallest percentage changes respectively. From 2019-20, CA-932 (250.2%) and IL-603 (−36.8%) were the largest and smallest respectively. Among Medicaid patients in 2018, there was a 1,932.1-fold difference in prescriptions per 100k Medicaid enrollees between Kentucky (12,075.5) and Nebraska (6.25). Among Medicare enrollees in 2018, family medicine physicians and other primary care providers were the top buprenorphine prescribers. This study found overall increases in buprenorphine availability but also pronounced state-level differences. Such geographic analysis can be used to determine which public policies and regional factors impact access to buprenorphine.Ethics StatementHereby, I Justina A. Warnick consciously assure that for the manuscript “An Analysis of Patterns of Distribution of Buprenorphine in the United States using ARCOS, Medicaid, and Medicare Databases” the following is fulfilled:This material is the authors’ own original work, which has not been previously published elsewhere aside from preprint server MedRxiv.The paper is not currently being considered for publication elsewhere.The paper reflects the authors’ own research and analysis in a truthful and complete manner.The paper properly credits the meaningful contributions of co-authors and co-researchers.The results are appropriately placed in the context of prior and existing research.All sources used are properly disclosed (correct citation). Literally copying of text must be indicated as such by using quotation marks and giving proper reference.All authors have been personally and actively involved in substantial work leading to the paper and will take public responsibility for its content.I acknowledge that the violation of the Ethical Statement rules may result in severe consequences.Graphical Abstract