Opioid analgesic stewardship, increasing access to medications for opioid use disorder (MOUD), and overdose prevention education and naloxone distribution are key strategies promoted to address the ongoing opioid overdose crisis (U.S. Department of Health and Human Services, 2021, Walsh et al., 2020). Unfortunately, despite the expanding availability of these interventions in recent years, opioid-involved overdose deaths continue to increase (Mattson et al., 2021).

The release of the 2016 Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain (hereafter as CDC 2016 Guideline) was associated with an acceleration in the decline of prescribing practices associated with opioid-related harms (Bohnert et al., 2018). However, experts, including the authors of the CDC 2016 Guideline, have expressed concern about unintended consequences from misapplication of the CDC 2016 Guideline, including from rapid opioid tapers (Dowell et al., 2019, Kroenke et al., 2019). Evidence is emerging that opioid analgesic tapering practices are increasing and associated with harms that are greater with increased taper rapidity (Agnoli et al., 2021, FDA, 2019, Fenton et al., 2019). Some have expressed concern that the heightened regulatory environment around opioid analgesic prescribing may have produced a chilling effect that may lead clinicians to decrease or stop prescribing altogether (Islam and McRae, 2014).

Buprenorphine is a highly effective MOUD, associated with improved outcomes and reduced mortality (Mattick et al., 2014, Sordo et al., 2017). Buprenorphine can be prescribed in standard medical settings once providers have either obtained a Drug Addiction Treatment Act of 2000 (DATA) waiver or have submitted a notice to the Substance Abuse and Mental Health Services Administration of their intent to prescribe buprenorphine under the recently released Practice Guideline for the Administration of Buprenorphine for Treating Opioid Use Disorder, making it a highly scalable treatment (Federal Register, 2021; Wakeman and Barnett, 2018). The rate of buprenorphine prescribing has more than doubled from 2009 to 2018 (Olfson et al., 2020). One of the 12 recommendations from the CDC 2016 Guideline is that individuals identified as having opioid use disorder (OUD) should be offered or referred to evidence-based treatment, including buprenorphine (Dowell et al., 2016).

Secular decreases in opioid analgesic prescribing have been well described, but the degree to which clinicians may have decreased or discontinued opioid analgesic prescribing by clinician specialty is unknown. Furthermore, while buprenorphine prescribing for OUD has increased in recent years and can be prescribed in the same settings as opioid analgesics for chronic pain, it is unclear if these practices are siloed among different specialties. We sought to examine national trends in the number of prescribers and number of prescriptions dispensed for opioid analgesics and buprenorphine to better understand underlying secular trends.