Factors affecting willingness to provide buprenorphine treatment

Abstract

Buprenorphine is an effective long-term opioid agonist treatment. As the only pharmacological treatment for opioid dependence readily available in office-based settings, buprenorphine may facilitate a historic shift in addiction treatment from treatment facilities to general medical practices. Although many patients have benefited from the availability of buprenorphine in the United States, almost half of current prescribers are addiction specialists suggesting that buprenorphine treatment has not yet fully penetrated general practice settings. We examined factors affecting willingness to offer buprenorphine treatment among physicians with different levels of prescribing experience. Based on their prescribing practices, physicians were classified as experienced, novice, or as a nonprescriber and asked to assess the extent to which a list of factors impacted their prescription of buprenorphine. Several factors affected willingness to prescribe buprenorphine for all physicians: staff training; access to counseling and alternate treatment; visit time; buprenorphine availability; and pain medications concerns. Compared with other physicians, experienced prescribers were less concerned about induction logistics and access to expert consultation, clinical guidelines, and mental health services. They were more concerned with reimbursement. These data provide important NIH Public Access

Integrating Buprenorphine Treatment into Office-based Practice: a Qualitative Study

“…Physician comfort implementing buprenorphine maintenance treatment increases as a function of experience 26 . Contrary to the expectations of some participants, expertise in mental health and addictions is not a prerequisite for providing office-based buprenorphine maintenance treatment, and as such, uptake is more likely related to the scope of practice that physicians wish to undertake-as is seen in the realms of HIV treatment and pain management 27 .…”

Barriers to Primary Care Physicians Prescribing Buprenorphine

“…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.…”

The Supply of Physicians Waivered to Prescribe Buprenorphine for Opioid Use Disorders in the United States: A State-Level Analysis

“…Considerable work has examined its diffusion in SUD treatment programs and OTPs (Brigham et al, 2007;Ducharme & Abraham, 2008;Ducharme et al, 2007;Friedmann et al, 2010;Gordon et al, 2007;Knudsen et al, 2006Knudsen et al, , 2009Koch et al, 2006;Kovas et al, 2007;Wallack et al, 2010). Several surveys of physicians have examined the nexus between attitudes and prescribing (Arfken et al, 2010;Kissin et al, 2006;Netherland et al, 2009;Reif et al, 2007;Thomas et al, 2008;WESTAT, 2006).…”