The opioid epidemic continues to ravage the U.S. Though buprenorphine is an effective medication treatment for opioid use disorder, access to treatment remains challenging, especially for rural patients. Until January 2023, clinicians who wanted to provide buprenorphine were required to obtain a waiver from the Drug Enforcement Administration (DEA). In 2020, the percentage of rural counties without any waivered clinician to prescribe buprenorphine was 36.9%, more than twice the rate in urban counties (15.3%).

The removal of the waiver requirement may impact some clinicians' decisions on whether to add buprenorphine to their practices. Past work by the WWAMI Rural Health Research Center has shown that nearly one in five rural physicians (19.0%) with a DEA waiver to prescribe buprenorphine who reported they were not using their waiver cited concerns of DEA intrusion as a barrier. The requirement to register rather than have a waiver (with a specific patient limit) may mitigate these concerns. Many clinicians will also still be required to take a one-time 8-hour approved training. All prescribers will be required to register with the DEA and check a box to confirm they have met the training requirement or are exempt based on their prior training in addiction medicine.

The historically low rate of prescribing buprenorphine and the uncertain impacts of waiver policy change call for continued tracking of the availability of these services for rural patients to identify where treatment gaps exist. This study aims to examine changes in prescribing over time to determine if lifting the requirement has resulted in increased access to buprenorphine by answering the following questions:

1. How has the proportion of rural vs. urban clinicians who are prescribing buprenorphine for opioid use disorder changed since the waiver requirement was eliminated?
2. How has the average number of rural vs. urban patients with opioid use disorder that clinicians are treating with buprenorphine changed since the waiver requirement was lifted?
3. Which types of clinicians in rural vs. urban areas have added buprenorphine treatment to or eliminated it from their practice since the waiver was eliminated?
4. How do these patterns vary by patient demographics including race, ethnicity, and rurality?