Uptake of a Treatment for Opioid Use Disorder is Highly Uneven Across the United States

Rutgers and Columbia researchers investigate overall increased use of a long-acting injectable buprenorphine, but large disparities persist

There was a substantial increase in recent years in the use of a form of the primary medication to treat opioid use disorder, according to a Rutgers Health study.

Researchers also noted sharp differences in growth trends across the United States.

The first long-acting injectable form of buprenorphine, the most common medication for treating opioid use disorder, was approved by the Food and Drug Administration for use in 2018. As a partial rather than full blocker of the opioid receptor, it blocks the effects of opioid drugs such as heroin or fentanyl and reduces risk of overdose. Long-acting injectables deliver buprenorphine via a shot, slowly releasing it into the bloodstream over a full month to provide a steady level of medication over time, as opposed to sublingual or oral forms.

The study, published in Health Affairs, examined pharmacy prescription claims from 2021 to 2024, including more than 4 billion prescriptions dispensed annually. Researchers explored state-level trends in the volume of long-acting injectable buprenorphine prescriptions as well as trends in insurance payer type, such as Medicaid, Medicare, commercial or self-pay and prescriber specialty, such as physicians or advanced practice clinicians.

"The data showed a rapid uptake of long-acting injectable buprenorphine, with the total number of buprenorphine prescriptions in injectable form increasing tenfold from 2021 to 2024," said Stephen Crystal, the director of the Rutgers Center for Health Services Research and a coauthor of the study. "This matters because an injectable formulation could be lifesaving for those patients who struggle to stabilize on a daily oral medication. Sustained levels of medication, potentially reducing cravings for illicit drugs and assured protection for a full month may reduce the risk of overdose, particularly for individuals at high risk, such as those treated for prior overdose or in unstable living situations."

These findings highlight the crucial role of Medicaid, as well as advanced practice clinicians, rather than physicians in combating the opioid crisis.

Stephen Crystal

Director, Rutgers Center for Health Services Research

Researchers observed marked increases in prescriptions for patients with Medicaid insurance benefits, the joint federal and state program that provides free or low-cost health coverage to low-income or disabled Americans. Pennsylvania, Louisiana, Alaska and Ohio had the highest rates of long-acting injectable prescriptions, possibly because of policies of their Medicaid plans that made this type of buprenorphine more accessible, according to researchers.

While overall prescription increases were observed, researchers noted significant differences in growth trends across states. In some states, less than 1% of buprenorphine prescribed was in long-acting injectable form, and in other states, close to 13% of buprenorphine was prescribed in injectable form by 2024.

"Given the variation across states, it's evident that state-level policy decisions and insurance plan designs have a meaningful impact on expanding access to lifesaving opioid-use disorder treatment," said Arthur Robin Williams, an associate professor at Columbia University and the lead author of the study.

Researchers also found disproportionate increases in long-acting injectable buprenorphine prescriptions among advanced practice clinicians, such as nurse practitioners and physician assistants.

"These findings highlight the crucial role of Medicaid, as well as advanced practice clinicians, rather than physicians in combating the opioid crisis," said Crystal, who is also a Distinguished Research Professor at Rutgers School of Social Work.

Coauthors include Mark Olfson of Columbia University and Hillary Samples and Jialiang Hua of Rutgers Institute for Health.

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