23 Jul Dynamic changes in buprenorphine distribution to pharmacies and hospitals in the United States
Maria Gikoska
MedicalResearch.com Interview with:
Maria Gikoska, MBS
Geisinger College of Health Sciences
Scranton, PA 18509
MedicalResearch.com: What is the background for this study?
Response: Opioid use disorder (OUD) is a chronic condition that continues to substantially impact public health in the United States (U.S.), with approximately 5.7 million people affected in 2023.
Buprenorphine, a partial mu-opioid receptor agonist, is widely used for treating OUD due to its safety profile, high treatment retention, and effectiveness in reducing opioid-related mortality. Since its approval in 2002, its use has increased, though not uniformly across states. Factors such as the now- eliminated X-waiver, telemedicine expansions during the COVID-19 pandemic, and differing state level policies have influenced buprenorphine access. The study sought to evaluate national and state-level pattern in buprenorphine distribution from 2019-2023 to understand disparities and inform public health interventions.
MedicalResearch.com: What were the key points of your research?
Response: We examined the use of buprenorphine in the U.S. using the comprehensive Automated Reports and Consolidated Orders System by the Drug Enforcement Administration and U.S. Census Bureau Population Estimates. On the national level, pharmacy distribution consistently increased from 2019 to 2023, although the growth slowed from 12.2% for 2019-2020 to 4-5% annually from 2020-2023. Hospital distribution showed more variability, with an initial 20.3% increase (2019-2020), followed by smaller gains. State level distribution was uneven across states. Nebraska, Arkansas, South Dakota, and Kansas showed the highest increases in pharmacy distribution, while the District of Columbia saw the largest decrease. California had a pronounced increase in hospital distribution (+1,043.6%). Additionally, COVID-19 related policy changes, such as telehealth expansion, played an appreciable role in increasing access to buprenorphine, particularly in outpatient settings.
MedicalResearch.com: Was the outcome compatible with your premise or were the results surprising?
Response: Yes, the outcome was largely compatible with the study’s premise. The research hypothesized that buprenorphine distribution would continue to increase following the COVID-19 pandemic, driven by expanded telemedicine services and policy changes. The results confirmed this, with overall upward trends in distribution across most states and both types of dispensing sites. However, a surprising finding included pronounced state-level differences, such as Hawaii’s reversal from the most negative (decreasing) to the most positive (increasing) percent change in hospital distribution. We were also surprised by the lack of a distribution increase post X-waiver removal, which highlighted ongoing systemic barriers like provider capacity, readiness and stigma.
MedicalResearch.com: What further questions remain to be answered? What further research is indicated?
Response: Despite the increases in buprenorphine distribution identified in this study, several important questions remain unanswered. One critical area involves evaluating how state-level policy differences- particularly proactive versus restrictive regulatory environments affect buprenorphine access and outcomes for individuals with OUD.
While this study focused on distribution volume by drug weight, it lacked patient-level data, limiting the ability to assess demographic disparities in treatment access, such as differences by race or insurance status. Future research should investigate these demographic and socioeconomic factors more thoroughly. Additionally, understanding how buprenorphine is used in combination with other supportive interventions, such as mental health services and social support systems, may offer insight into more holistic approaches to OUD treatment.
Another important direction includes evaluating the effects of removing the federal X-waiver, especially in the context of ongoing provider hesitancy and stigma, which may still pose substantial barriers despite policy improvements. Additional research is needed to differentiate buprenorphine prescribed for OUD from prescriptions for chronic pain, since the ARCOS database does not distinguish between formulations or indications. Future studies should also explore regional variations in overdose rates and treatment outcomes relative to buprenorphine availability, helping identify which interventions were most effective in reducing mortality and improving recovery. Such investigations would offer a greater understanding of how buprenorphine can be more effectively utilized against the opioid crisis.
Citation: Gikoska M, et al. An analysis of buprenorphine distribution patterns among pharmacies and hospitals in the United States from 2019-2023. BMJ Open; 2025, https://pubmed.ncbi.nlm.nih.gov/40685232/
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Last Updated on July 23, 2025 by Marie Benz MD FAAD