Physicians’ experiences with buprenorphine: A qualitative study of motivations for becoming X waivered and barriers to and facilitators of prescribing the medication for opioid use disorder

McCollum, C. Greer; Eaton, Ellen; Creger, Thomas; Lee, Aaron; Gagnon, Kelly; Li, Li

doi:10.1016/j.drugalcdep.2023.109777

Cited by 6 publications

(2 citation statements)

References 27 publications

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“…A survey of these providers found that patient complexity and lack of available community-based behavioral health treatment supports were among the main reasons they limited their practices. (See also, [50] , [51] ).…”

Section: Discussionmentioning

confidence: 98%

Mental health and substance use disorder comorbidities among Medicaid beneficiaries: Associations with opioid use disorder and prescription opioid misuse

Swartz,

Franceschini,

Scamperle

2023

AIMSPH

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<abstract><sec> <title>Background</title> Medicaid presently insures about one-fourth of the US population and disproportionately insures about 38 % of non-elderly adults with an opioid use disorder (OUD). Owing to Medicaid's prominent role insuring persons with an OUD and that Medicaid coverage includes pharmaceutical benefits, there has been considerable interest in studying potential prescription opioid misuse among Medicaid beneficiaries and identifying subpopulations at higher risk for misuse and possible progression to an OUD. </sec><sec> <title>Methods</title> The study goals were to explore the associations among prescription opioid misuse, OUD, and co-occurring mental health and other substance use disorders (SUD). We analyzed Illinois Medicaid 2018 claims data for 1102479 adult beneficiaries 18 to 64 years of age. Using algorithms based on previous studies, we first determined either the presence or absence of nine SUDS (including OUD), nine mental health disorders and likely prescription opioid misuse. Then, we subdivided the beneficiary sample into five groups: those who were prescribed opioids and evidenced either no, possible, or probable misuse; those evidencing an OUD; and those evidencing no opioid use or misuse. </sec><sec> <title>Results</title> Bivariate analyses, upset plots, and multinomial logistic regressions were used to compare the five subgroups on the prevalence of co-occurring SUDS and mental health disorders. Those with an OUD or with probable prescription opioid misuse had the highest prevalence of most co-occurring conditions with beneficiaries with an OUD the most likely to evidence co-occurring SUDS, particularly tobacco use disorder, whereas those with probable misuse had elevated prevalence rates of co-occurring mental health disorders comparable to those with an OUD. </sec><sec> <title>Conclusion</title> The medical complexity of persons with an OUD or misusing prescription opioids are considered in light of recent attempts to expand buprenorphine provision as a medication for OUD among Medicaid beneficiaries. Additionally, we consider the possibility of gender, co-occurring mental health disorders, and tobacco use disorder as important risk factors for progressing to prescription opioid misuse and an OUD. </sec></abstract>

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Section: Discussionmentioning

confidence: 98%

Mental health and substance use disorder comorbidities among Medicaid beneficiaries: Associations with opioid use disorder and prescription opioid misuse

Swartz,

Franceschini,

Scamperle

2023

AIMSPH

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“…Prior research found that it was perceived as too burdensome for practitioners to fit X-waiver training into their already busy schedules. 34 To address this concern, we provided three virtual training courses that allowed practitioners to complete their training hours in more than one training module. Thus, being flexible for practitioners to complete required training hours at their own pace could be an option to increase the number of waivered practitioners and expand access to MOUD.…”

Section: Study Strengths and Limitationsmentioning

confidence: 99%

Impact of Virtual X-waiver Training on Perceptions of Barriers and Facilitators to Medications for opioid Use Disorder

2023

J Addict & Prev

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Background: DATA 2000 X-waiver training has existed for over 20 years, however, less than 10% of eligible practitioners have been waivered. The purpose of this study was to understand practitioners' perceptions of X-waiver training and to assess the feasibility of virtual X-waiver training.Methods: Three separate virtual X-waiver training courses were provided from December 2020 through September 2021. Pre-and posttraining surveys were developed to understand practitioners' attitudes toward patients with opioid use disorder (OUD) and to evaluate the effect of the training. All participants were invited to complete surveys anonymously via Qualtrics.Results: Among 168 participants, 140 and 133 completed pre-and post-training surveys, respectively. Analysis of the pre-training survey data showed that 80% of practitioners were willing to treat patients with OUD. Post-training responses documented significant improvements in diagnosing OUD and recognizing opioid withdrawal symptoms. Similarly, post-training results showed 96% of respondents noted improved confidence in their capacity to prescribe buprenorphine. Approximately 69% of respondents in the pre-training survey were not aware of local community resources to refer patients for substance use treatment; this was reduced to 34% in post-training responses. Postsurvey qualitative data revealed that participants thought the virtual training was efficient, however, suggested more in-person interaction and lecture-based discussion. In addition, respondents continued to report persistent barriers to implementation of buprenorphine prescribing. Conclusion:This study demonstrated the feasibility of delivering X-waiver training virtually. In addition, X-waiver training improved practitioners' knowledge and comfort in identifying and managing OUD although persistent barriers to buprenorphine prescribing remain despite training.their patients with OUD due to a variety of reasons, including but not limited to, stigma associated with this patient population and lack of training and expertise.[8-10] Thus, it is not surprising that in Jefferson County, the most populous county in Alabama, less than 20% of eligible patients receive evidence based MOUD. [7] Taking this into account, educating practitioners, assisting waivered practitioners in delivering MOUD, and expanding MOUD training to include nonaddiction medicine physicians is urgently needed to increase capacity to treat patients with OUD in Alabama.To address the overwhelming need, the University of Alabama at Birmingham (UAB) was awarded a grant through the Foundation for Opioid Response Efforts to provide X-waiver training to practitioners primarily at UAB Hospital and Cahaba Medical Care Foundation using a multidisciplinary approach. UAB Hospital is the largest medical center in the Southeast region, and Cahaba Medical Care Foundation is a Federal Qualified Health Clinic (FQHC), also located in Jefferson County, Alabama, serving over 20,000 patients annually. The educational objectives were: (1) to understand the pract...

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Evaluation of medications used for opioid use disorder in emergency departments: A cross-sectional analysis of the 2020 National Hospital Ambulatory Medical Care Survey

Lee,

Sun,

Vakkalanka

2024

The American Journal of Emergency Medicine

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Physicians’ experiences with buprenorphine: A qualitative study of motivations for becoming X waivered and barriers to and facilitators of prescribing the medication for opioid use disorder

Cited by 6 publications

References 27 publications

Mental health and substance use disorder comorbidities among Medicaid beneficiaries: Associations with opioid use disorder and prescription opioid misuse

Mental health and substance use disorder comorbidities among Medicaid beneficiaries: Associations with opioid use disorder and prescription opioid misuse

Impact of Virtual X-waiver Training on Perceptions of Barriers and Facilitators to Medications for opioid Use Disorder

Evaluation of medications used for opioid use disorder in emergency departments: A cross-sectional analysis of the 2020 National Hospital Ambulatory Medical Care Survey

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