Physician Training is Never a Failure

Gordon, Adam J.; Liberto, Joseph; Granda, Stephanie E.; Salmon-Cox, Sara; Andrée, Tykia; McNicholas, Laura F.

doi:10.1080/10550490902931373

Cited by 9 publications

(8 citation statements)

References 11 publications

(11 reference statements)

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“…In contrast, despite the substantial increase in the number of 30‐patient‐waivered physicians in both urban and rural areas, our findings regarding the relationship between 30‐patient‐waivered physicians and the amount of buprenorphine dispensed in recent years suggest that many of the physicians waivered to treat 30 patients may actually be treating few or no patients with buprenorphine, which is consistent with earlier research findings . A variety of factors extending beyond the DEA certification process could influence a physician's decision about whether to treat patients with buprenorphine.…”

Section: Discussionsupporting

confidence: 87%

Where Is Buprenorphine Dispensed to Treat Opioid Use Disorders? The Role of Private Offices, Opioid Treatment Programs, and Substance Abuse Treatment Facilities in Urban and Rural Counties

et al. 2015

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Buprenorphine is an effective opioid dependence treatment that has expanded access to care since its 2002 approval, but it can only be prescribed by physicians waivered to treat a limited number of individuals. We examined the impact of 2006 legislation that increased waivered physician patient limits from 30 to 100 on buprenorphine use, and found that 100‐patient‐waivered physicians were significantly associated with growth in buprenorphine use, with no such relationship for 30‐patient‐waivered physicians. Policies relaxing patient limits may be more effective in increasing buprenorphine use than alternatives such as opening new substance abuse treatment facilities or increasing the overall number of waivered physicians. Context Opioid use disorders are a significant public health problem. In 2002, the FDA approved buprenorphine as an opioid use disorder treatment when prescribed by waivered physicians who were limited to treating 30 patients at a time. In 2006, federal legislation raised this number to 100 patients. Although federal legislators are considering increasing these limits further and expanding prescribing privileges to nonphysicians, little information is available regarding the impact of such changes on buprenorphine use. We therefore examined the impact of the 2006 legislation—as well as the association between urban and rural waivered physicians, opioid treatment programs, and substance abuse treatment facilities—on buprenorphine distributed per capita over the past decade. Methods Using 2004‐2011 state‐level data on buprenorphine dispensed and county‐level data on the number of buprenorphine‐waivered physicians and substance abuse treatment facilities using buprenorphine, we estimated a multivariate ordinary least squares regression model with state fixed effects of a state's annual total buprenorphine dispensed per capita as a function of the state's number of buprenorphine providers. Findings The amount of buprenorphine dispensed has been increasing at a greater rate than the number of buprenorphine providers. The number of physicians waivered to treat 100 patients with buprenorphine in both rural and urban settings was significantly associated with increased amounts of buprenorphine dispensed per capita. There was no significant association in the growth of buprenorphine distributed and the number of physicians with 30‐patient waivers. Conclusions The greater amounts of buprenorphine dispensed are consistent with the potentially greater use of opioid agonists for opioid use disorder treatment, though they also make their misuse more likely. The changes after the 2006 legislation suggest that policies focused on increasing the number of patients that a single waivered physician could safely and effectively treat could be more effective in increasing buprenorphine use than would alternatives such as opening new substance abuse treatment facilities or raising the overall number of waivered physicians.

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Section: Discussionsupporting

confidence: 87%

Where Is Buprenorphine Dispensed to Treat Opioid Use Disorders? The Role of Private Offices, Opioid Treatment Programs, and Substance Abuse Treatment Facilities in Urban and Rural Counties

et al. 2015

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“…Future analyses, however, should seek to incorporate additional available information that can serve as proxies for the demand for treatment for opioid use disorders. We also acknowledge that the presence of a waivered physician as a proxy for a physician prescribing buprenorphine to patients is only adequate, as a substantial number of waivered physicians are not actively treating patients (Adam J Gordon et al, 2011; Adam J Gordon, Liberto, et al, 2008; Adam J Gordon et al, 2009), and many others may not be prescribing to the full number of patients allowed under their waiver.…”

Section: Discussionmentioning

confidence: 99%

Supply of buprenorphine waivered physicians: The influence of state policies

Stein

Gordon

Dick

et al. 2015

Journal of Substance Abuse Treatment

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Buprenorphine, an effective opioid use disorder treatment, can be prescribed only by buprenorphine-waivered physicians. We calculated the number of buprenorphine-waivered physicians/100,000 county residents using 2008–11 Buprenorphine Waiver Notification System data, and used multivariate regression models to predict number of buprenorphine-waivered physicians/100,000 residents in a county as a function of county characteristics, state policies and efforts to promote buprenorphine use. In 2011, 43% of US counties had no buprenorphine-waivered physicians and 7% had 20 or more waivered physicians. Medicaid funding, opioid overdose deaths, and specific state guidance for office-based buprenorphine use were associated with more buprenorphine-waivered physicians, while encouraging methadone programs to promote buprenorphine use had no impact. Our findings provide important empirical information to individuals seeking to identify effective approaches to increase the number of physicians able to prescribe buprenorphine.

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“…Attempts are being made to remedy this problem, but are still far behind the existing need. Within VHA, the educational and support efforts that exist around buprenorphine consideration and prescribing—such as disseminating up-to-date information regarding best evidence in prescribing, supporting a peer mentor system, and providing educational activities for prescribers and staff (Gordon, Gepper, et al, 2009; Gordon, Liberto, et al, 2009; Gordon et al, 2008)—might act as a template. A recent review of barriers to utilization of pharmacotherapy for addiction disorders by Oliva, Maisel, Gordon, and Harris (2011) also offers a few suggestions including greater training in medical schools and other training programs, dissemination of “best practices” guidelines, especially to front-line treatment staff, and requiring formal training for providers and agencies that provide alcohol pharmacotherapy for alcohol dependence.…”

Section: Discussionmentioning

confidence: 99%

Pharmacotherapy for alcohol dependence: Perceived treatment barriers and action strategies among Veterans Health Administration service providers.

Harris

Ellerbe

Reeder

et al. 2013

Psychological Services

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Although access to and consideration of pharmacological treatments for alcohol dependence are consensus standards of care, receipt of these medications by patients is generally rare and highly variable across treatment settings. The goal of the present project was to survey and interview the clinicians, managers, and pharmacists affiliated with addiction treatment programs within Veterans Health Administration (VHA) facilities to learn about their perceptions of barriers and facilitators regarding greater and more reliable consideration of pharmacological treatments for alcohol dependence. Fifty-nine participants from 19 high-adopting and 11 low-adopting facilities completed the survey (facility-level response rate = 50%) and 23 participated in a structured interview. The top 4 barriers to increased consideration and use of pharmacotherapy for alcohol dependence were consistent across high- and low-adopting facilities and included perceived low patient demand, pharmacy procedures or formulary restrictions, lack of provider skills or knowledge regarding pharmacotherapy for alcohol dependence, and lack of confidence in treatment effectiveness. Low patient demand was rated as the most important barrier for oral naltrexone and disulfiram, whereas pharmacy or formulary restrictions were rated as the most important barrier for acamprosate and extended-release naltrexone. The 4 strategies rated across low- and high-adopting facilities as most likely to facilitate consideration and use of pharmacotherapy for alcohol dependence were more education to patients about existing medications, more education to health care providers about medications, increased involvement of physicians in treatment for alcohol dependence, and more compelling research on existing medications. This knowledge provides a foundation for designing, deploying, and evaluating targeted implementation efforts.

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Physician Training is Never a Failure

Cited by 9 publications

References 11 publications

Where Is Buprenorphine Dispensed to Treat Opioid Use Disorders? The Role of Private Offices, Opioid Treatment Programs, and Substance Abuse Treatment Facilities in Urban and Rural Counties

Where Is Buprenorphine Dispensed to Treat Opioid Use Disorders? The Role of Private Offices, Opioid Treatment Programs, and Substance Abuse Treatment Facilities in Urban and Rural Counties

Supply of buprenorphine waivered physicians: The influence of state policies

Pharmacotherapy for alcohol dependence: Perceived treatment barriers and action strategies among Veterans Health Administration service providers.

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