Variation in Naloxone and Buprenorphine Prescribing in LA County's Safety-Net System

Objective

To describe patients and visits with identified, probable opioid use disorder (OUD) in Los Angeles County’s (LAC) safety-net system and examine rates of naloxone and buprenorphine prescribing across healthcare settings.

Design

A descriptive analysis of electronic health record data. Setting: LAC’s largest safety-net provider, the LAC Department of Health Services.

Patients

This study included 3,881 patients with 5,580 visits involving probable OUD from July 2022 to June 2023.

Main Outcome Measures

Visit-level analysis was performed to identify treatment settings where patients accessed care. We compared rates of buprenorphine and naloxone prescription across treatment settings using Chi-square tests and 95 percent confidence intervals.

Results

Visits with identified OUD most often occurred in outpatient settings (36 percent) compared to inpatient (31 percent), emergency (24 percent), or urgent care (8 percent) settings. Overall, 35.8 percent of visits included a naloxone prescription, and 30.4 percent included a buprenorphine prescription. Prescription rates varied significantly by treatment setting.

Conclusions

Most visits with probable OUD did not include naloxone or buprenorphine prescriptions, and prescription receipt varied by setting.