Barriers to Primary Care Physicians Prescribing Buprenorphine

Abstract

PURPOSE Despite the efficacy of buprenorphine-naloxone for the treatment of opioid use disorders, few physicians in Washington State use this clinical tool. To address the acute need for this service, a Rural Opioid Addiction Management Project trained 120 Washington physicians in 2010-2011 to use buprenorphine. We conducted this study to determine what proportion of those trained physicians began prescribing this treatment and identify barriers to incorporating this approach into outpatient practice. METHODSWe interviewed 92 of 120 physicians (77%), obtaining demographic information, current prescribing status, clinic characteristics, and barriers to prescribing buprenorphine. Residents and 7 physicians who were prescribing buprenorphine at the time of the course were excluded from the study. We analyzed the responses of the 78 remaining respondents.RESULTS Almost all respondents reported positive attitudes toward buprenorphine, but only 22 (28%) reported prescribing buprenorphine. Most (95%, n = 21) new prescribers were family physicians. Physicians who prescribed buprenorphine were more likely to have partners who had received a waiver to prescribe buprenorphine. A lack of institutional support was associated with not prescribing the medication (P = .04). A lack of mental health and psychosocial support was the most frequently cited barrier by both those who prescribe and who do not prescribe buprenorphine.CONCLUSION Interventions before and after training are needed to increase the number of physicians who offer buprenorphine for treatment of addiction. Targeting physicians in clinics that agree in advance to institute services, coupled with technical assistance after they have completed their training, their clinical teams, and their administrations is likely to help more physicians become active providers of this highly effective outpatient treatment. 2014;128-133. doi:10.1370/afm.1595. Ann Fam Med INTRODUCTIONI n 2000, the passage of the Drug Addiction Treatment Act enabled qualifying physicians to receive a waiver from the special registration requirement of the Controlled Substances Act to prescribe buprenorphine-naloxone for the treatment of opioid use disorders. Buprenorphinenaloxone, hereafter referred to as buprenorphine, is the only treatment available to office-based physicians that has high rates of prolonged success for the treatment of opioid addiction.1,2 Although physicians have reported a wide range of barriers that have dissuaded them from prescribing buprenorphine, [3][4][5][6][7][8][9][10][11][12][13][14][15][16] few studies specifically addressed the barriers family practice physicians encounter. McCarty et al 10 found that 6 of 17 Oregonian family physicians trained to use buprenorphine prescribe it, whereas those who do not prescribe buprenorphine cited concerns of being overwhelmed by needy patients, the cost of medication, reimbursement, being the only physician prescribing buprenorphine in the practice, and lack of administrative support. Even though Walley et al, 15 in his ...

Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder

“…[8][9][10] The only other national survey of physicians providing buprenorphine maintenance treatment 13 found that physicians with waivers whose names were found on a public locator list and those whose names were not reported financial concerns (59.3% and 71.8%, respectively), more often than they reported diversion concerns (18.7% and 26.3% respectively). Our findings show the opposite trend: more physicians, regardless of prescribing status, were concerned about diversion than finances.…”

“…5,6 A few studies, limited to 1 or only a few states, have looked at the barriers physicians face providing buprenorphine maintenance treatment, but none has examined nationally the differences between physician groups who are and are not actively using their waivers or accepting new patients. [7][8][9][10] This study's purpose was to understand the barriers physicians with waivers face in providing buprenorphine maintenance treatment.…”

Now is the Time to Address Substance Use Disorders in Primary Care

“…[7][8][9][10] Yet most primary care physicians are not waivered to prescribe buprenorphine, and most who are, choose not to prescribe it. [11][12][13][14] The research brief by Andrilla outlines the multiple barriers 14 that rural physicians face in prescribing buprenorphine for opioid use disorders, such as regulatory requirements for a waiver to prescribe buprenorphine. 15 There are resources to promote the confidence and skill of the practitioner.…”

Enhancing Transitions from Addiction Treatment to Primary Care

“…31,32 These potential obstacles are significant in that >40% of physicians allowed to treat patients with buprenorphine had not done so, and of those who had, 25% stated that these challenges had caused them to reduce or discontinue this treatment. 33 Greater incentives and clinical support have been identified as potentially facilitating expansion of buprenorphine maintenance therapy into primary care 34,35 which could be used as a model for enhancing SUD care within this setting.…”