Shortage of Buprenorphine Prescribing Physicians Providing Maternity Care
Drug overdose deaths have increased dramatically in the United States. Opioid use disorder (OUD) and opioid-related overdoses contribute to nearly one in five pregnancy-related deaths and are a major cause of death after delivery.
Medication-assisted treatment (MAT) is an effective treatment for OUD, and buprenorphine is Federal Drug Administration approved for pregnant women. Physicians, nurse practitioners and physician assistants are eligible for a MAT waiver with additional training. In a recent study published in the Annals of Family Medicine, researchers examined three years of data from the American Board of Family Medicine’s National Family Medicine Graduate Survey and found that, out of over 5,100 respondents, only 153 family physicians said they deliver babies and prescribe buprenorphine, and another 108 said they provide maternity care and prescribe buprenorphine, but do not deliver babies. Additionally, the family physicians who care for pregnant women and prescribe buprenorphine were trained in a small number of residency programs. Fifteen of 614 family medicine residencies trained 25% of graduates who provide this care.
“A very small number of family physicians are being trained to prescribe buprenorphine and to care for pregnant patients. These doctors are largely concentrated in urban areas and were trained in a small number of residencies. This is a crucial workforce that we need to work hard to expand through policy,” said lead author Joshua St. Louis, MD, MPH, AAHIVS, core faculty, Lawrence Family Medicine Residency.
The number of family physicians caring for pregnant women with OUD may be 10 times larger than the number of obstetrician-gynecologists caring for these patients. In 2012, 4,066 family physicians held the waiver to prescribe buprenorphine compared to only 181 obstetrician-gynecologists. The number of family physicians providing care for pregnant women with OUD in the United States appears to be very limited, concentrated in urban areas, and are largely made up of graduates who trained in a small number of residency programs. Federal and state support for including buprenorphine waiver training in family medicine and obstetrics-gynecology residency programs could increase the ability to reach this particularly vulnerable patient population and significantly reduce unnecessary deaths of pregnant women.