Abstract
This study examines trends in buprenorphine dispensing from retail pharmacies to adolescents and young adults aged 10 to 24 years in the US from 2020 to 2023.
In 2023, 712 000 adolescents and young adults aged 12 to 25 years reported an opioid use disorder in the past year.1 Buprenorphine is the only US Food and Drug Administration–approved medication for opioid use disorder for adolescents aged 16 years or older.2 Despite recommendations for buprenorphine use among adolescents and young adults, the rate of buprenorphine dispensing to youths aged 19 years or younger decreased 25% from 2015 to 2020.3 Since then, increased buprenorphine prescribing flexibilities, including telehealth prescriptions and elimination of the waiver requirement, have aimed to improve access.4 We examined trends in buprenorphine dispensing from retail pharmacies to adolescents and young adults in the US from 2020 to 2023.
Methods
This cross-sectional study analyzed 2020-2023 data from IQVIA Total Patient Tracker, an all-payer pharmaceutical claims database capturing 93% of prescriptions dispensed from retail pharmacies in the US. Estimates of unique individuals dispensed buprenorphine are projected by IQVIA to be representative of all prescriptions dispensed from retail pharmacies in the US. Annual estimates of individuals dispensed buprenorphine were obtained for adolescents and young adults overall, by age group (10-15, 16-17, 18-19, and 20-24 years), and by prescriber specialty. Annual rates of individuals dispensed buprenorphine per 100 000 persons were calculated using US Census Bureau population estimates. Annual percentage changes (APCs) and 95% CIs were calculated using the National Cancer Institute’s Joinpoint Regression Program (version 5.0.3), with P < .05 (2-sided) considered statistically significant. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. The Centers for Disease Control and Prevention determined that institutional review board review was not applicable because deidentified secondary data were used in accordance with 45 CFR §46.
Results
Between 2020 and 2023, the overall number of adolescents and young adults dispensed buprenorphine declined 6.5% annually (95% CI, −7.0% to −6.0%; P < .001), from 47 759 individuals in 2020 to 38 907 in 2023 (Table 1). The overall decline was driven by the larger population of young adults aged 20 to 24 years who experienced significant decreases in dispensing (APC, −8.7%; 95% CI, −9.4% to −8.0%; P < .001), from 44 442 to 33 685 individuals. Meanwhile, the number of adolescents dispensed buprenorphine increased but absolute numbers remained low—from 67 to 188 for those aged 10 to 15 years (APC, 39.4% [95% CI, 19.7%-62.4%]; P < .001), from 335 to 1026 for those aged 16 to 17 years (APC, 45.3% [95% CI, 36.7%-54.6%]; P < .001), and from 2966 to 4111 for those aged 18 to 19 years (APC, 11.1% [95% CI, 6.4%-15.9%]; P < .001).
Table 1. Individuals Dispensed Buprenorphine, by Age Group—US, 2020-2023.
| No. (rate per 100 000 persons) of individuals dispensed buprenorphine by calendar yeara | APC, % (95% CI)b | |||||
|---|---|---|---|---|---|---|
| 2020 | 2021 | 2022 | 2023 | For No. | For rate | |
| Total adolescents and young adults aged 10-24 y | 47 759 (73.0) | 44 604 (68.4) | 42 092 (64.5) | 38 907 (61.1) | −6.5 (−7.0 to −6.0) | −5.7 (−6.3 to −5.2) |
| Age, y | ||||||
| 10-15 | 67 (0.3) | 116 (0.5) | 146 (0.6) | 188 (0.8) | 39.4 (19.7 to 62.4) | 41.2 (21.4 to 64.4) |
| 16-17 | 335 (3.9) | 509 (5.9) | 743 (8.6) | 1026 (12.0) | 45.3 (36.7 to 54.6) | 45.4 (37.7 to 53.8) |
| 18-19 | 2966 (32.6) | 3519 (40.5) | 3775 (43.8) | 4111 (48.1) | 11.1 (6.4 to 15.9) | 13.3 (6.5 to 20.6) |
| 20-24 | 44 442 (201.3) | 40 593 (180.5) | 37 508 (165.2) | 33 685 (153.6) | −8.7 (−9.4 to −8.0) | −8.6 (−10.7 to −6.4) |
Abbreviation: APC, annual percentage change.
Data source: IQVIA Total Patient Tracker, 2020-2023. Population data for each age group and year were obtained from the US Census Bureau (https://www.census.gov/topics/population/age-and-sex/data/tables.2023.List_897222059.html#list-tab-List_897222059).
P < .001 for all APCs.
Buprenorphine dispensing varied by prescriber specialty (Table 2). Nurse practitioners prescribed more buprenorphine to adolescents and young adults than other specialties. Significant increases were observed in 7 of 13 specialty groups among adolescents, and significant decreases were observed in 8 specialty groups among young adults. Pediatricians prescribed to the fewest number of adolescents in 2020 but had the largest increase from 2020 to 2023 (from 71 to 201; APC, 34.8% [95% CI, 5.8%-72.0%]; P = .008).
Table 2. Adolescents (Aged 10-19 Years) and Young Adults (Aged 20-24 Years) Dispensed Buprenorphine, by Prescriber Specialty—US, 2020-2023.
| Prescriber specialty | No. of individuals dispensed buprenorphine by calendar year and age, ya | APC for age 10-19 y, % (95% CI) | P value | APC for age 20-24 y, % (95% CI) | P value | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2020 | 2021 | 2022 | 2023 | |||||||||
| 10-19 | 20-24 | 10-19 | 20-24 | 10-19 | 20-24 | 10-19 | 20-24 | |||||
| Addiction medicine | 95 | 1120 | 93 | 1028 | 107 | 1058 | 156 | 1265 | 17.7 (−7.9 to 51.6) | .21 | 4.0 (−11.9 to 23.4) | .58 |
| Anesthesia, pain, or physical medicine and rehabilitation | 93 | 2024 | 111 | 1456 | 125 | 1398 | 114 | 1075 | 7.6 (−8.0 to 26.1) | .32 | −17.6 (−23.6 to −11.2) | <.001 |
| Emergency medicine | 237 | 2201 | 327 | 2297 | 375 | 2424 | 516 | 2358 | 28.0 (17.2 to 40.0) | <.001 | 2.6 (−0.9 to 6.3) | .15 |
| Family practice | 751 | 10 481 | 899 | 8522 | 955 | 7119 | 948 | 5746 | 7.9 (−3.9 to 21.4) | .22 | −18.0 (−19.0 to −17.0) | <.001 |
| General practiceb | 505 | 7582 | 572 | 5954 | 662 | 5424 | 804 | 4612 | 16.7 (12.0 to 21.6) | <.001 | −14.7 (−17.6 to −11.6) | <.001 |
| Internal medicine | 388 | 6193 | 412 | 5103 | 394 | 4011 | 378 | 3022 | −1.2 (−6.3 to 4.2) | .53 | −21.3 (−25.7 to −16.4) | <.001 |
| Nurse practitioners | 1215 | 17 364 | 1566 | 18 668 | 1978 | 18 742 | 2403 | 18 345 | 25.6 (21.1 to 30.3) | <.001 | 1.7 (−3.8 to 7.7) | .44 |
| Other specialtyc | 78 | 789 | 114 | 1032 | 133 | 1027 | 180 | 994 | 30.5 (22.1 to 39.6) | <.001 | 7.1 (−9.2 to 26.6) | .34 |
| Other medical or pediatric subspecialties | 186 | 3674 | 204 | 2748 | 163 | 2049 | 214 | 1780 | 2.0 (−8.3 to 13.2) | .75 | −21.9 (−27.0 to −16.3) | <.001 |
| Pediatricsd | 71 | 761 | 119 | 543 | 104 | 487 | 201 | 431 | 34.8 (5.8 to 72.0) | .008 | −16.6 (−24.1 to −8.2) | <.001 |
| Physician assistants | 362 | 6194 | 514 | 6336 | 702 | 6508 | 839 | 6048 | 32.8 (20.1 to 47.0) | <.001 | −0.4 (−5.3 to 4.7) | .79 |
| Psychiatry | 571 | 7216 | 651 | 5625 | 669 | 4385 | 716 | 3359 | 7.3 (4.2 to 10.5) | <.001 | −22.5 (−23.2 to −21.7) | <.001 |
| Surgical specialties | 83 | 1372 | 69 | 836 | 64 | 624 | 52 | 443 | −13.7 (−17.9 to −9.4) | <.001 | −30.8 (−34.6 to −26.9) | <.001 |
Abbreviation: APC, annual percentage change.
Data source: IQVIA Total Patient Tracker, 2020-2023. IQVIA includes the prescriber’s primary specialty based on the specialty designated by the original source. IQVIA also seeks to validate the information by direct confirmation with the prescriber, with the specialty indicated by direct confirmation overriding the primary specialty from other sources if they do not match.
Includes osteopathic medicine.
Includes other, unspecified specialty, pharmacists, clinical pharmacology, dentistry, optometry, clinical neurophysiology, medical microbiology, and nutrition.
Includes internal medicine–pediatrics, which accounts for 19% to 42% of individuals dispensed buprenorphine by pediatrics specialties among adolescents (aged 10-19 years) and 19% to 38% among young adults (aged 20-24 years) between 2020-2023.
Discussion
Between 2020 and 2023, buprenorphine dispensing increased among adolescents but decreased among young adults. The increases likely reflect successful outreach to pediatricians, enhanced prescribing through telehealth, and elimination of waiver requirements4; these changes might differentially affect young adults, who might be less likely to access health care.5 The reasons for decreases among young adults are unclear but might reflect lower opioid use disorder prevalence or changes in treatment-seeking behaviors or health care coverage among young adults with substance use disorders and should be further explored. Despite some positive trends, buprenorphine dispensing to adolescents and young adults remains low. In 2023, 712 000 adolescents and young adults aged 12 to 25 years had opioid use disorder.1 Meanwhile, in this study, 38 907 adolescents and young adults aged 10 to 24 years were dispensed buprenorphine in 2023, indicating that many adolescents and young adults who might benefit from this treatment did not receive it. Barriers to buprenorphine among adolescents and young adults may include few treatment facilities, lack of comfort with medications for opioid use disorder among youth-serving clinicians, and stigma related to opioid use disorder.6
Study limitations include a lack of data on diagnoses, prescriptions dispensed outside retail pharmacies, prescriptions written (vs dispensed), and the clinical setting or specialty for nurse practitioners and physician assistants.
Youth-serving clinicians and health systems can expand access to buprenorphine for adolescents and young adults through clinician education, improving resources to support substance use care for youths, linking to medications for opioid use disorder and behavioral health services, and addressing stigma and other barriers to care.6
Section Editors: Kristin Walter, MD, and Jody W. Zylke, MD, Deputy Editors; Karen Lasser, MD, MPH, Senior Editor.
Data Sharing Statement
References
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Supplementary Materials
Data Sharing Statement
