| dc.description.abstract | Buprenorphine is one of the most effective treatments for opioid use disorder (OUD), but it is largely underused despite rising trends in opioid-related mortality. We investigated three aims to address the treatment gaps for buprenorphine. The first aim introduced a network analytic framework to delineate the diffusion process behind buprenorphine waiver adoption via social contagion. Using national shared patient data and the universe of buprenorphine waivered primary care physicians, we found that the global measures of connectivity, i.e., eigenvector and complex centralities, are strong predictors for the diffusion of buprenorphine. This suggests that peer networks and social norms are likely driving forces for buprenorphine adoption. The second aim studied the effects of emergency scope of practice (SOP) expansions for nurse practitioners during the COVID-19 pandemic on buprenorphine supply and waiver adoption. We used a synthetic difference-in-differences with staggered timing approach and found that nurse practitioner SOP expansions did not increase either buprenorphine prescribing or waiver adoption for nurse practitioners. This suggests that SOP expansions may not be sufficient to increase buprenorphine prescribing. The third aim examined the treatment landscape for adolescents regarding substance use, mental health conditions, and treatments. We found that 13% of adolescents have a substance use disorder and that only 6% of these adolescents had received treatment for drugs. We have also found treatment gaps for mental health services, treatment for drugs and specialty care once adolescents with substance use disorders reach adulthood. Finally, we found that minors receive significantly less buprenorphine than young adults, indicating the increased need to address treatment barriers for this population. Together, these dissertation chapters inform policy and practice mechanisms to increase buprenorphine access in the United States. | |
