Geographic analysis of military health system (MHS) buprenorphine prescribers and patients

Fuad Issa, MD, FAPA; Christine Nguyen, MHA, PMP; Orolo Davies Abili, PharmD; Ruth F. Quah, MPH; Michael I. Engler, MPH; Jennifer G. Greenberg, MPH; MAJ Raquel Giunta, PharmD, BCPS; CAPT Paul A. Gobourne, MSN, BC-FNP; Amy J. Osik, MS; CDR John A. Hodgson MD; Christopher Spevak, MD, MPH, JD

doi:10.5055/jom.2021.0646

Authors

Fuad Issa, MD, FAPA
Christine Nguyen, MHA, PMP
Orolo Davies Abili, PharmD https://orcid.org/0000-0002-4165-2262
Ruth F. Quah, MPH
Michael I. Engler, MPH
Jennifer G. Greenberg, MPH
MAJ Raquel Giunta, PharmD, BCPS
CAPT Paul A. Gobourne, MSN, BC-FNP
Amy J. Osik, MS
CDR John A. Hodgson MD
Christopher Spevak, MD, MPH, JD

DOI:

https://doi.org/10.5055/jom.2021.0646

Keywords:

buprenorphine, waiver, policy, geographic, MHS, military, TRICARE

Abstract

Objective: To demonstrate the prevalence of opioid use disorder (OUD) in the military health system (MHS), geographically map OUD patients and providers, and offer policy recommendations to help increase buprenorphine waiver prescribing.

Design: This study was a retrospective review of data from the MHS records. Deidentified records of MHS OUD patients receiving buprenorphine were utilized. Secondary data with nonpersonally identifiable information (PII) were used for pulling records of buprenorphine prescribing providers within the direct care system (MHS providers) and providers from the purchased care system (civilian facilities accepting TRICARE beneficiaries).

Setting: This study reviewed records of individuals within the MHS, in the United States, and its territories.

Patients and participants: Patients within the MHS system with a diagnosis of OUD. Providers, within the MHS or purchased care, who had prescribed buprenorphine were selected.

Main outcome measured: The number of OUD patients in the MHS and providers caring for these OUD patients. In addition, geographical maps illustrating the dispersion of OUD patients, and prescribers were created.

Results: The vast majority of MHS OUD patients receive their care from purchase care. Between 2015 and 2018, there has been a shift in the number OUD diagnosed patients by region, and the number of OUD prescribers.

Conclusion: The MHS population, particularly active duty, is a transient population. As such, it is not a surprise that the population of OUD patients or prescribers varied by region during that time period. Furthermore, results demonstrate that there is a need to increase the number of buprenorphine-waivered prescribers within the MHS. Changes in policy may encourage more providers to obtain the waiver or increase patient load.

Author Biographies

Fuad Issa, MD, FAPA

Chief, Clinical Care, Psychological Health Center of Excellence, DHA R&D, Silver Spring, Maryland; Clinical Professor of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC

Christine Nguyen, MHA, PMP

Research Portfolio Management, Research Program Administration (RPA), J-9, Defense Health Agency (DHA), Silver Spring, Maryland

Orolo Davies Abili, PharmD

Sole Provider Coordinator/ Clinical Pharmacist, Department of Anesthesia/Pain Management, Walter Reed National Military Medical Center, Bethesda, Maryland

Ruth F. Quah, MPH

Data Analyst, Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland; Salient CRGT, Inc., Fairfax, Virginia

Michael I. Engler, MPH

Data Analyst, Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland; Salient CRGT, Inc., Fairfax, Virginia

Jennifer G. Greenberg, MPH

Data Analyst, Psychological Health Center of Excellence, Defense Health Agency, Silver Spring, Maryland; Salient CRGT, Inc., Fairfax, Virginia

MAJ Raquel Giunta, PharmD, BCPS

Deputy Chief, Pharmacy Department, Walter Reed National Military Medical Center, Bethesda, Maryland

CAPT Paul A. Gobourne, MSN, BC-FNP

Walter Reed National Military Medical Center, Bethesda, Maryland

Amy J. Osik, MS

Senior Program Manager, National Capital Region Pain Initiative & Tele-Pain Program, Walter Reed National Military Medical Center, Bethesda, Maryland

CDR John A. Hodgson MD

Program Director, NCC Anesthesiology Residency, Walter Reed National Military Medical Center, Bethesda, Maryland

Christopher Spevak, MD, MPH, JD

Professor of Clinical Anesthesia, Georgetown University School of Medicine, Program Director Pain Fellowship, Walter Reed National Military Medical Center, Bethesda, Maryland

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