Alden Mileto

Eleven-Fold Regionally Selective Differences in Buprenorphine Increases in Pennsylvania Interview with:
Alden MiletoAlden Mileto, BA
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, PA What is the background for this study?

Response: The drug buprenorphine is a partial opioid agonist, originally developed in the 1960s as an alternative to the stronger full opioid mu receptor agonists like morphine. Today, the drug is sometimes used for pain, but is more often used as a treatment for Opioid Use Disorder (OUD). Since the 2002 federal approval for buprenorphine use in treatment of OUD, there has been an increase in buprenorphine prescription across all states.

However recent studies have showed a disproportionate increase in buprenorphine prescriptions to rural/ less populated areas in comparison to urban/densely populated areas. The objective of this study [1] was to analyze the trends in buprenorphine distribution, overall and by three-digit zip codes, in Pennsylvania from 2010-2020. What are the main findings?

Response:  In Pennsylvania, the amount of buprenorphine distributed increased 217.3% from 116.3 kg in 2010 to 369.0 kg in 2020. The distribution of buprenorphine was not equal amongst different population density areas. Three of the least population dense areas showed a statistically significant increase buprenorphine distribution from 2010-2020: 155 (Somerset), 169 (Wellsboro), and 177 (Williamsport). The 155-zip code (Somerset) experienced the largest percent increase (885%). In contrast, the 190-zip (Philadelphia) experienced the smallest increase (79%). A common pattern was observed which showed, on average, the 3-digit zip codes with the lowest population densities showed immense increases in buprenorphine distribution while some of the highest population density areas showed less pronounced increases in buprenorphine distribution. What should readers take away from your report?

Response: The increase in buprenorphine distribution was expected due to the increased prevalence of Opioid Use Disorder and its treatment. The increase in distribution was eleven-fold greater in Somerset relative to Philadelphia. The disparities in PA buprenorphine distribution align with reports from other states and it is a multifaceted observation that cannot be attributed to one explanation. The availability of methadone from opioid treatment programs in Philadelphia and incentive structures (i.e. low patient out of pocket expenses for methadone compared to buprenorphine) may contribute. As the increase of buprenorphine distribution continues, it is important to be aware of its importance in the treatment of Opioid Use Disorder, but also health care disparities in the availability of this evidence-based pharmacotherapy [2]. What recommendations do you have for future research as a results of this study?

Response: As the distribution of buprenorphine has increased, the number of providers available to distribute buprenorphine has not similarly risen. This is limited by U.S. government’s X Waiver policy. In short, to be able to prescribe buprenorphine, a provider must have an X Waiver designation, which is a required certification that in itself limits the number of patients one can prescribe buprenorphine to. The number of PA providers with an X waiver designation may not be sufficient to cover the increasing need for buprenorphine.


  1. Mileto A, et al. Regional differences in buprenorphine distribution in Pennsylvania from 2010-2020. Guthrie Journal. 2022;
  2. Schuler MS, et al. Growing racial/ethnic disparities in buprenorphine distribution in the United States, 2007-2017. Drug Alcohol Depend. 2021; 223:108710.

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