Rise and regional disparities in buprenorphine utilization in the United States.

PURPOSE: Buprenorphine is an opioid partial agonist used to treat opioid use disorder. While several policy changes have attempted to increase buprenorphine availability, access remains well below optimal levels. This study characterized how buprenorphine utilization in the United States has changed over time and whether there are regional disparities in distribution of the medication. METHODS: The amount of buprenorphine distributed from 2007 to 2017 was obtained from the Drug Enforcement Administration's Automated Reports and Consolidated Ordering System. Data were expressed as the percent change and milligrams per person in each state. The formulations and cost for prescriptions covered by Medicaid (2008 to 2018) were also examined. RESULTS: Buprenorphine distributed to pharmacies increased about 7-fold (476.8 to 3179.9 kg) while the quantities distributed to hospitals grew 5-fold (18.6 to 97.6 kg) nationally from 2007 to 2017. Buprenorphine distribution per person was almost 20-fold higher in Vermont (40.4 mg/person) relative to South Dakota (2.1 mg/person). There was a strong association between the number of physicians authorized to prescribe buprenorphine and distribution per state (r[49] = +0.94, P < .0005). The buprenorphine/naloxone sublingual film (Suboxone) was the predominant formulation (92.6% of 0.31 million Medicaid prescriptions) in 2008 but accounted for less than three-fifth (57.3% of 6.56 million prescriptions) in 2018. CONCLUSIONS: Although buprenorphine availability has substantially increased over the last decade, distribution was very nonhomogeneous across the United States.

Examination of Potential Industry Conflicts of Interest and Disclosures by Contributors to Online Medical Resource Databases.

Importance: Physicians contribute content to online databases, and other health care professionals use these websites to support their decision-making. Financial conflicts of interest (COI) have the potential to adversely impact evidence-based patient care. Objectives: To quantify the potential COI among content contributors to 2 popular point-of-care medical resources, UpToDate and DynaMed, overall and by gender, and to compare self-reported and industry-mandated disclosures. Design, Setting, and Participants: This cross-sectional study compiled an initial list of contributors for each website using the Centers for Disease Control and Prevention's Leading Causes of Death. The top 50 causes were used to identify relevant articles from each database from November 30 to December 7, 2020. The authors and editors of those articles were investigated. Data were analyzed from January 2021 to March 2022. Main Outcomes and Measures: Self-reported contributor disclosure status was compared with financial remuneration as reported in the Centers for Medicare & Medicaid Services Open Payments (OP) database from 2013 to 2018. Results: A total of 179 point-of-care database authors and editors were assessed. Combined, they received $77.7 million, with a mean of $583 218 (95% CI, $0-$4 679 651) and median (range) of $29 073 ($10-$17 517 315) each. Most of the compensation ($68.1 million [87.6%]) went to UpToDate contributors. Of 128 UpToDate contributors, 76 (59.4%) reported nothing to disclose, and among these, 44 contributors (57.9%) had a record of receiving a financial payment on OP. Women UpToDate contributors received 2.5% of the total compensation paid from industry. The top 10 UpToDate contributors who received the most financial remuneration earned $56.1 million combined, were all men, and only 1 had a nothing-to-disclose status. Of 51 DynaMed contributors, 42 (82.4%) reported nothing to disclose, and among these, 35 contributors (83.3%) had an OP entry (mean, $79 820; 95% CI, $0-$400 774; median [range], $1403 [$26-$630 424]). Among the top 10 DynaMed contributors, 8 (80.0%) were men. Six of the top 10 DynaMed contributors reported nothing to disclose yet had an OP entry. Conclusions and Relevance: This cross-sectional study found that contributors to point-of-care databases were the recipients of nearly $78 million from pharmaceutical companies and medical device manufacturers, and these payments were often not disclosed in association with contributed content. Although these findings do not necessarily suggest ethical lapses among the physicians studied, point-of-care resource websites, like UpToDate and DynaMed, should consider implementing more stringent COI policies and employ an unbiased team to verify self-reported disclosure statuses among content contributors against OP reports.