Increasing Access to Medications for Opioid Use Disorder in Primary Care: Removing the Training Requirement May Not Be Enough

Russell, Holly Ann; Sanders, Mechelle; Meyer, Jessica K. V.; Loomis, Elizabeth; Mullaney, Teraisa; Fiscella, Kevin

doi:10.3122/jabfm.2021.06.210209

Cited by 15 publications

(14 citation statements)

References 13 publications

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“…Practical skill building is an integral aspect of UME; thus, incorporating training about MOUD into clinical skills practice is an important way to ensure students are actively engaging with material while highlighting the fact that patients who need MOUD can appear in any specialty. Existing evidence demonstrates the importance of practicing clinical skills and exposure to patients as part of training related to SUDs 41–44 . Education surrounding MOUD and other SUDs should be integrated throughout all years of UME and all aspects of training, not just clinical skills.…”

Section: Discussionmentioning

confidence: 99%

Optimizing buprenorphine training during undergraduate medical education: Medical student feedback and attitudes

et al. 2023

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Background and Objectives: Strong evidence supports efficacy of medications for opioid use disorder (MOUD), but stringent prescribing policies impair access. Many physicians report discomfort prescribing MOUD due to inadequate knowledge. Most medical students believe MOUD training should occur during undergraduate medical education (UME). As legislation surrounding buprenorphine prescribing shifts, it is timely to consider how best to incorporate MOUD training into UME. Methods: At the start of 3rd year, all students (n = 290) received a survey regarding experiences working with people with OUDs, and beliefs and knowledge regarding harm reduction and treatment. During orientation, students completed an 8-h online MOUD training. Afterwards, students completed another survey, including questions about training perceptions. Results: One-third of students (32.8%) completed MOUD training and both surveys. Before training, 60.0% had not heard of the waiver, but 82.1% endorsed interest in prescribing buprenorphine. Despite mixed feelings about training content and delivery, 79.1% believed future classes should receive it. Most thought it should be integrated longitudinally throughout the curriculum rather than as separate online training. Conclusion and Scientific Significance: Medical students want more MOUD education throughout their training; however, the 8-h online training may be lessthan-optimal. As this training is no longer required to prescribe buprenorphine, there is an opportunity to modify the content presented. There is an urgent need for physicians with the knowledge and willingness to treat patients with OUD. Introducing integrated training about MOUD should help future physicians feel confident in their knowledge to treat patients and comfortable applying for the waiver.

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Section: Discussionmentioning

confidence: 99%

Optimizing buprenorphine training during undergraduate medical education: Medical student feedback and attitudes

et al. 2023

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“…26 Interestingly, in a recent study in which primary care providers were offered free and easily accessible training together with wrap-around support with experienced mentors, only a small number of those who completed the study went on to apply for the buprenorphine waiver, and even fewer were prescribing buprenorphine 12 months after training. 27 This suggests that training and mentorship alone will not likely improve access to this lifesaving treatment.…”

Section: Discussionmentioning

confidence: 99%

Buprenorphine Waiver Attitudes Among Primary Care Providers

Lai

Croghan

Ebbert

2022

J Prim Care Community Health

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Background: Despite efforts to improve access to Medications for Opioid Use Disorder (MOUD), such as buprenorphine, the number of opioid overdoses in the United States continues to rise. In April 2021, the Department of Health and Human Services removed the mandatory training requirement to obtain a buprenorphine waiver; the goal was to encourage more providers to prescribe buprenorphine, thus improving access. Little is known about the attitudes on buprenorphine prescribing after this policy change. Objective: The primary objective was to assess attitudes among primary care providers toward the removal of the buprenorphine waiver training requirement. A secondary objective was to identify other barriers to prescribing buprenorphine. Methods: We conducted a survey between September 15 and October 13, 2021 to assess the overall beliefs on the effectiveness of MOUD and attitudes toward the removal of the waiver training, current knowledge of buprenorphine, current practice styles related to screening for and treating OUD, and attitudes toward prescribing buprenorphine in the future. This survey was sent to 890 Mayo Clinic primary care providers in 5 US states. Results: One hundred twenty-three respondents (13.8%) completed the survey; 35.8% respondents agreed that the removal of the waiver training was a positive step. These respondents expressed a greater familiarity with the different formulations, pharmacology, and titration of buprenorphine. This group was also more likely to prescribe (or continue to prescribe) buprenorphine in the future. Approximately one-third (34.4%) of respondents reported perceived institutional support in prescribing buprenorphine. This group expressed greater confidence in diagnosing OUD, had greater familiarity with the different formulations, pharmacology, and titration of buprenorphine, and was more likely to prescribe (or continue to prescribe) buprenorphine in the future. Respondents who have been in practice for 11 to 20 years since completion of training were most likely to refer all OUD patients to specialists. Conclusions: Results of our survey suggests that simply removing the mandatory waiver training requirement is insufficient in positively changing attitudes toward buprenorphine prescribing. A key barrier is the perceived lack of institutional support. Future studies investigating effective ways to provide such support may help improve providers’ willingness to prescribe buprenorphine.

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“…Primary care OBOT offers whole-person care for people with substance use disorders by treating for comorbid mental health and psychiatric conditions, integrating harm reduction and recovery support, and coordinating access to the continuum of care. Cited barriers to providing OBOT include financial sustainability of payment models (Hodgkin et al, 2021), time, competing priorities, lack of collaborating specialists, and stigma (Louie et al, 2019; Russell et al, 2021). Additionally, primary care implementing OBOT to respond to the opioid epidemic during the COVID-19 pandemic simultaneously adapted their systems of care to the imperative public health interventions.…”

mentioning

confidence: 99%

COVID-19 and practice transformation: Building an office-based opioid treatment program in a family medicine residency practice.

Colistra¹,

Chung²,

Harbove³

et al. 2023

Families, Systems, & Health

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Introduction: This brief report describes how a family medicine residency practice (FMRP) leveraged a resident-led quality improvement project and a grant-funded Addiction Integrated Care Team (AICT) to initiate an office-based opioid treatment (OBOT) program to provide medications for opioid use disorder during the COVID-19 pandemic. Method: In 2020, the practice experienced four disruptors that shifted motivation for practice development: (a) The COVID-19 pandemic demanded rapid change in primary care processes/staffing, including pivoting to telehealth/remote practice. (b) The practice’s transition to a federally qualified community health center model meant a shift in organizational priorities that required offering OBOT services. (c) External grant resources became available through the AICT program to support practice core for OBOT, and 10 implementation strategies were utilized. (d) A resident champion implemented an OBOT quality improvement project. Results: These efforts resulted in the practice offering the OBOT program and 18 patients receiving OBOT from January 2020 to February 2021, with 10 of 18 patients engaged for 12 months or longer. Further, the cumulative adoption and reach from January 2020 through September 2022 was 15 faculty and 14 residents becoming prescribers and 101 patients served within the OBOT program, respectively. Discussion: FMRPs striving for significant practice transformation, such as implementing an OBOT program during a pandemic, may benefit from synergistic guidance and resources including established theory, strategies from the implementation science literature, and resident-led quality improvement efforts.

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Increasing Access to Medications for Opioid Use Disorder in Primary Care: Removing the Training Requirement May Not Be Enough

Cited by 15 publications

References 13 publications

Optimizing buprenorphine training during undergraduate medical education: Medical student feedback and attitudes

Optimizing buprenorphine training during undergraduate medical education: Medical student feedback and attitudes

Buprenorphine Waiver Attitudes Among Primary Care Providers

COVID-19 and practice transformation: Building an office-based opioid treatment program in a family medicine residency practice.

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