1026. What Proportion of Infectious Diseases Physicians Have Buprenorphine Waivers to Treat Opioid Use Disorder in the United States?


 
 
 Since the onset of the COVID-19 pandemic, opioid-related overdose deaths have increased. Buprenorphine, a medication for opioid use disorder (OUD), is safe and effective but is underutilized and requires qualifying physicians to obtain a waiver. Infectious diseases (ID) physicians are uniquely positioned to treat OUD, as persons with OUD may present with infectious complications from injection drug use. We sought to understand the proportion and distribution of ID physicians with waivers in the United States (US).
 
 
 
 This was a cross-sectional study merging data from the Centers for Medicare & Medicaid Services and the Drug Enforcement Agency Substance Abuse and Mental Health Services Agency. Our primary outcome was proportion of ID physicians who possess buprenorphine waivers. We used multivariable regression models to identify individual and county-level characteristics associated with buprenorphine waiver possession. We used geospatial analysis to describe county-level distribution of buprenorphine-waivered ID physicians.
 
 
 
 Among 6439 ID physicians in the US, 170 (2.6%) possessed buprenorphine waivers. Overall, 57.2% of ID physicians were male with a median 23 (IQR 15-33) years since medical school. Most (97.3%) practiced in metropolitan counties. In multivariable analysis, medical school graduation beyond 20 years was associated with lower odds of waiver possession compared to those graduating within 20 years (OR 0.59, 95% CI 0.43-0.80). ID physicians practicing in counties with median income > 50,000/year and in counties with higher proportion of uninsured residents also had lower odds of having a waiver (OR 0.58, 95% CI 0.35-0.97; OR 0.93, 95% CI 0.90-0.97). Among counties with at least one ID physician (n=519), 86.6% had no buprenorphine-waivered ID physicians (Figure 1). Figure 1County-Level Distribution of Infectious Diseases Physicians with Buprenorphine Waivers
 
 
 
 Fewer than 3% of ID physicians in the US have obtained waivers to prescribe buprenorphine, highlighting missed opportunities to treat individuals with OUD, especially in rural America. Education on OUD management should be integrated into ID continuing medical education, and policies are urgently needed to expand buprenorphine access to persons without insurance.
 
 
 
 All Authors: No reported disclosures.
