Analysis of barriers to adoption of buprenorphine maintenance therapy by family physicians

Abstract

Introduction: Opioid abuse has reached epidemic levels. Evidence-based treatments such as buprenorphine maintenance therapy (BMT) remain underutilized. Offering BMT in primary care settings has the potential to reduce overall costs of care, decrease medical morbidity associated with opioid dependence, and improve treatment outcomes. However, access to BMT, especially in rural areas, remains limited. This article will present a review of barriers to adoption of BMT among family physicians in a primarily rural area in the USA. Methods: An anonymous survey of family physicians practicing in Vermont or New Hampshire, two largely rural states, was conducted. The survey included both quantitative and qualitative questions, focused on BMT adoption and physician opinions of opioids. Specific factors assessed included physician factors, physicians' understanding of patient factors, and logistical issues. Results: One-hundred and eight family physicians completed the survey. Approximately 10% were buprenorphine prescribers. More than 80% of family physicians felt they regularly saw patients addicted to opiates. The majority (70%) felt that they, as family physicians, bore responsibility for treating opiate addiction. Potential logistical barriers to buprenorphine adoption included inadequately trained staff (88%), insufficient time (80%), inadequate office space (49%), and cumbersome regulations (37%). Common themes addressed in open-ended questions included lack of knowledge, time, or interest; mistrust of people with addiction or buprenorphine; and difficult patient population. Conclusions: This study aims to quantify perceived barriers to treatment and provide insight expanding the community of family physicians offering BMT. The results suggest family physicians are excellent candidates to provide BMT, as most report regularly seeing opioid-addicted patients and believe that treating opioid addiction is their responsibility. Significant barriers remain, including inadequate staff training, lack of access to addiction experts, and perceived efficacy of BMT. Addressing these barriers may lower resistance to buprenorphine adoption and increase access to BMT in rural areas.

Engaging Adolescents in the Fight Against Drug Abuse and Addiction: A Concept Mapping Approach

“…However, urban centers were less likely to offer specialized treatment options for adolescents. Other studies have also revealed a poorer quality of care, less access to care and more financial barriers in urban and rural treatment settings compared with suburban treatment settings (DeFlavio et al, 2015; Dew et al, 2007; Higgins et al, 2019; Hirchak & Murphy, 2017). There is a clear need to focus on removing barriers that affect the level of drug education and treatment provided within underserved rural and urban communities.…”

Medications for Opioid Use Disorder in the Criminal/Legal System: Knowledge, Beliefs, and Attitudes Among Rural Community-Based Stakeholders

“…A recent systematic review identified several “consumer-focused,” and “provider-focused” barriers to MOUD care in rural areas (Lister, Weaver, Ellis, Himle, & Ledgerwood, 2020). For instance, consumer-focused barriers (Ellis, Konrad, Thomas, & Morrissey, 2009; Kaufman et al, 2016) included the dearth of MOUD treatment options available to rural residents with OUD, while provider-focused studies (Andrilla, Coulthard& Larson, 2017; DeFlavio, Rolin, Nordstrom, & Louis A Kazal, 2015; Jones, 2018; McCarty, Gustafson, Capoccia, & Cotter, 2004) referenced barriers related to availability and acceptability of MOUD in rural communities (Lister et al, 2020). Anticipated stigma, whereby individuals come to expect particular forms of discriminatory treatment (Turan et al 2017; Van Brakel et al 2019), has also been identified as a barrier associated with MOUD—particularly agonist therapies—such that reinforcing negative attitudes may become internalized, and negatively impact on individuals’ mental health and willingness to utilize treatment (Crapanzano, Hammarlund, Ahmad, Hunsinger, & Kullar, 2018).…”

Patient- and Provider-Reported Experiences of a Mobile Novel Digital Therapeutic in People With Opioid Use Disorder (reSET-O): Feasibility and Acceptability Study

“…A key systemic barrier that has been identified is the lack of access to behavioral intervention and counseling to accompany MOUD prescribing [ 16 - 18 ]. Behavioral interventions have the potential to address poor adherence to medication.…”