Open Access Open Access  Restricted Access Subscription or Fee Access

Geographic analysis of military health system (MHS) buprenorphine prescribers and patients

Fuad Issa, MD, FAPA, Christine Nguyen, MHA, PMP, Orolo Davies Abili, PharmD, Ruth F. Quah, MPH, Michael I. Engler, MPH, Jennifer G. Greenberg, MPH, MAJ Raquel Giunta, PharmD, BCPS, CAPT Paul A. Gobourne, MSN, BC-FNP, Amy J. Osik, MS, CDR John A. Hodgson MD, Christopher Spevak, MD, MPH, JD


Objective: To demonstrate the prevalence of opioid use disorder (OUD) in the military health system (MHS), geographically map OUD patients and providers, and offer policy recommendations to help increase buprenorphine waiver prescribing.

Design: This study was a retrospective review of data from the MHS records. Deidentified records of MHS OUD patients receiving buprenorphine were utilized. Secondary data with nonpersonally identifiable information (PII) were used for pulling records of buprenorphine prescribing providers within the direct care system (MHS providers) and providers from the purchased care system (civilian facilities accepting TRICARE beneficiaries).

Setting: This study reviewed records of individuals within the MHS, in the United States, and its territories.

Patients and participants: Patients within the MHS system with a diagnosis of OUD. Providers, within the MHS or purchased care, who had prescribed buprenorphine were selected.

Main outcome measured: The number of OUD patients in the MHS and providers caring for these OUD patients. In addition, geographical maps illustrating the dispersion of OUD patients, and prescribers were created.

Results: The vast majority of MHS OUD patients receive their care from purchase care. Between 2015 and 2018, there has been a shift in the number OUD diagnosed patients by region, and the number of OUD prescribers.

Conclusion: The MHS population, particularly active duty, is a transient population. As such, it is not a surprise that the population of OUD patients or prescribers varied by region during that time period. Furthermore, results demonstrate that there is a need to increase the number of buprenorphine-waivered prescribers within the MHS. Changes in policy may encourage more providers to obtain the waiver or increase patient load.



buprenorphine, waiver, policy, geographic, MHS, military, TRICARE

Full Text:



Military Health System: MHS facilities. Available at Accessed December 2019.

Farmer CM, Tanielian T, Buttorff C, et al.: Integrating department of defense and department of veterans affairs purchased care: Preliminary feasibility assessment. 2018. Available at Accessed December 2019.

Kime P: Combat troops at higher risk for opioid, heroin addiction, study says. Available at Accessed December 2019.

National Institute on Drug Abuse: Opioid overdose crisis. Available at Accessed December 2019.

Bliley THR: 2634-106th congress. Drug addiction treatment act of 2000. 1999-2000. Available at Accessed December 2019.

American Society of Addiction Medicine: Buprenorphine. Available at Accessed December 2019.

SAMHSA: Buprenorphine. Available at Accessed December 2019.

Military Health System: Mdr, m2, ICDS functional references and specifications. Available at Accessed December 2019.

Military Health System: Military health system management analysis and reporting tool. Available at Accessed December 2019.

Military Health System: Defense medical information system (DMIS) identifier (ID) tables. Available at Accessed December 2019.

Department of Defense: Medical expense and performance reporting systems for fixed military medical and dental treatment facilities. Available at Accessed December 2019.

Andrilla CH, Coulthard C, Larson EH: Barriers rural physicians face prescribing buprenorphine for opioid use disorder. Ann Fam Med. 2017; 15(4): 359-362. Available at Accessed January 2020.

Department of Defense: Report to Congressional Defense Committees opioid abuse and non-opiate pain management in the military requested by House Report 115-769, page 298 to accompany H.R. 6157, the Department of Defense Appropriations Bill, 2019. Available at Accessed January 2020.

Cesur R, Sabia J, Bradford WD: National bureau of economic research. Did the war on terror ignite an opioid epidemic? (Working paper no. 26264). DOI: 10.3386/w26264.

Rae Olmsted KL, Brown JM, Vandermaas-Peeler R, et al.: Mental health and substance abuse treatment stigma among soldiers. Mil Psychol. 2011; 23(1): 52-64. Available at Accessed January 2020.

American Association of Nurse Practitioners: Comprehensive Addiction and Recovery Act (CARA). Available at Accessed January 2020.

Varghese R, Johnson K, Feng B, et al.: Buprenorphine prescribing by nurse practitioners. Available at Accessed January 2020.

Jones CM, Mccance-Katz EF: Characteristics and prescribing practices of clinicians recently waivered to prescribe buprenorphine for the treatment of opioid use disorder. Addiction. 2019; 114(3): 471-482. DOI: 10.1111/add.14436.

Huhn AS, Dunn KE: Why aren’t physicians prescribing more buprenorphine? J Subst Abuse Treat. 2017; 78: 1-7. DOI: 10.1016/j.jsat.2017.04.005.



  • There are currently no refbacks.