Overcoming Barriers to Prescribing Buprenorphine for the Treatment of Opioid Use Disorder: Recommendations from Rural Physicians

Abstract

Purpose The United States is in the midst of a severe opioid use disorder epidemic. Buprenorphine is an effective office‐based treatment that can be prescribed by physicians, nurse practitioners, and physician assistants with a Drug Enforcement Administration (DEA) waiver. However, many providers report barriers that keep them from either getting a DEA waiver or fully using it. The study team interviewed rural physicians successfully prescribing buprenorphine to identify strategies for overcoming commonly cited barriers for providing this service. Methods Interview candidates were randomly selected from a list of rurally located physicians with a DEA waiver to prescribe buprenorphine who reported treating high numbers of patients on a 2016 survey. Forty‐three rural physicians, who were prescribing buprenorphine to a high number of patients, were interviewed about how they overcame prescribing barriers previously identified in that survey. Findings Interviewed physicians reported numerous ways to overcome common barriers to providing buprenorphine treatment in rural areas. Key recommendations included ways to (1) get started and maintain medication‐assisted treatment, (2) minimize DEA intrusion and medication diversion, and (3) address the lack of mental health providers and stigma surrounding opioid use disorder (OUD). Overall, physicians found providing this service to be very rewarding. Conclusions Despite known barriers, rural physicians around the country have been successful in adding buprenorphine treatment to their practices. Nonprescribing providers can learn from the strategies used by successful prescribers to add this service.

Prescribing Practices of Nurse Practitioners and Physician Assistants Waivered to Prescribe Buprenorphine and the Barriers They Experience Prescribing Buprenorphine

“…28,29 Numerous strategies to overcome diversion concerns have been reported, such as expanding the health care team by developing relationships with dispensing pharmacists. [30][31][32] Educating waivered providers about these strategies may help mitigate the impact of concerns about diversion on providers' decisions to prescribe buprenorphine.…”

Comparing Buprenorphine-Prescribing Physicians Across Nonmetropolitan and Metropolitan Areas in the United States

“…A recent qualitative study of rural buprenorphine-prescribing physicians identified strategies used to overcome barriers to delivering buprenorphine treatment. 34 Concerns about diversion and misuse and not wanting to be perceived as being inconsistent or too lenient in a small community, which could attract patients who may be perceived as potentially taking advantage of the situation, encouraged physicians to establish clear requirements for treatment and included many who required patients to attend some form of psychosocial treatment especially at the beginning of treatment. 34 Despite these challenges, many physicians also reported high satisfaction and fulfillment with respect to delivering this important treatment.…”

Characteristics of Office-Based Buprenorphine Prescribers for Medicare Patients

“…regarded as the specialty with the most extensive OUD training, primary care specialties may have a greater role in bridging access gaps, particularly in rural and urban underserved communities established as health professional shortage areas. [12][13][14] Little is known about provider-level characteristics for outpatient buprenorphine provision reimbursed by any payer model. 15 Although nurse practitioners and physician assistants can also now become DATA-2000 waivered, most states still require physician oversight, especially with controlled substances.…”