Survey of Barriers and Facilitators to Prescribing Buprenorphine and Clinician Perceptions on the Drug Addiction Treatment Act of 2000 Waiver

Lanham, Holly J.; Papac, Jennifer; Olmos, Daniela I; Heydemann, Emily L.; Simonetti, Nathalia; Schmidt, Susanne; Potter, Jennifer

doi:10.1001/jamanetworkopen.2022.12419

Cited by 44 publications

(41 citation statements)

References 31 publications

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“…Training to obtain the buprenorphine waiver has been cited as a barrier to increasing access to MOUD. 9,24,25 The removal of the mandatory waiver training in April 2021 should theoretically reduce this barrier and improve access to treatment. Our study demonstrates that only 35.8% of primary care respondents felt that the removal of this training was a positive step toward improving access.…”

Section: Discussionmentioning

confidence: 99%

“…7 Changes or removal of the waiver training was noted to be a potential facilitator to applying for the waiver. 9 In April 2021, the Department of Health and Human Services removed the mandatory training requirement to prescribe buprenorphine. 10 With this change, providers no longer need to take the mandatory training before they can apply for the waiver.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Buprenorphine Waiver Attitudes Among Primary Care Providers

Lai

Croghan

Ebbert

2022

J Prim Care Community Health

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“…With the removal of the mandated training hours necessary to obtain an X-Waiver to prescribe buprenorphine, residency programs may not feel the need to encourage focused education on MAT treatment. However, the problems surrounding the X-Waiver requirement seem to have stemmed from complexities of the entire waiver process and getting started rather than a lack of desire for the training itself [ 26 ]. The removal of the training requirement of the X-Waiver reduces significant structural barriers, but clinicians have repeatedly cited lack of knowledge and training as a fundamental barrier to MAT delivery [ 5 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Didactic Training on Barriers and Biases to Treatment of Opioid Use Disorder: Meeting the Ongoing Needs of Patients with Opioid Use Disorder in the Emergency Department during the COVID-19 Pandemic

et al. 2022

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In the wake of COVID-19, morbidity and mortality due to Opioid Use Disorder (OUD) is beginning to emerge as a second wave of deaths of despair. Medication assisted treatment (MAT) for opioid use disorder MAT delivered by Emergency Medicine (EM) providers can decrease mortality due to OUD; however, there are numerous cited barriers to MAT delivery. We examined the impact of MAT training on these barriers among EM residents in an urban, tertiary care facility with a large EM residency. Training included the scripted and standardized content from the Provider Clinical Support System curriculum. Residents completed pre- and post-training surveys on knowledge, barriers, and biases surrounding OUD. We performed Wilcoxon matched-pairs signed-ranks test to detect statistical differences. Of 74 residents, 49 (66%) completed the pre-training survey, and 34 (69%) of these completed the follow-up survey. Residents reported improved preparedness to treat aspects of OUD across all areas queried, reported decreased perception of barriers to providing MAT, and increased comfort prescribing naloxone, counseling patients, prescribing buprenorphine, and treating opioid withdrawal. A didactic training on MAT was associated with residents reporting improved comfort providing buprenorphine and naloxone. As the wake of morbidity and mortality from both COVID and OUD continue to increase, programs should offer dedicated training on MAT.

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“…Most waivered clinicians do not regularly prescribe buprenorphine. 12 The research of Lanham et al 11 builds on prior work seeking to understand why many waivered clinicians do not prescribe buprenorphine. 4 They surveyed clinicians attending a waiver training to identify barriers and facilitators to obtaining their waiver and, subsequently, prescribing buprenorphine.…”

Section: Beyond Trainingmentioning

confidence: 99%

Beyond the Waiver: Multilevel Interventions Needed to Expand Buprenorphine Treatment

Samuels

Martin

2022

JAMA Netw Open

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over 100 000 people died from an overdose, more than any prior 12-month period. 1 Most overdose deaths involve opioids, predominantly fentanyl analogs. 1 Opioid agonist medications for opioid use disorder (OUD), methadone and buprenorphine, reduce mortality and overdose and improve person-centered outcomes. 2 There are an estimated 2.7 million people with OUD living in the US, and expanding access to buprenorphine is a key component of our national strategy to reduce overdose deaths; however, few people with OUD receive any medication for OUD. 3 Many factors contribute to the low provision of buprenorphine treatment for OUD. 4 A leading factor is the limited availability of buprenorphine prescribers. In 2018, more than 40% of counties in the US did not have any clinicians permitted to prescribe buprenorphine, and more than half of the counties with the greatest treatment need had inadequate treatment capacity. 5 Treatment has expanded during the last decade, but it has been unevenly distributed, and buprenorphine access remains highly restricted, particularly in rural areas and in minoritized racial and ethnic communities. 5,6 To prescribe buprenorphine for OUD, Drug Enforcement Administration (DEA)-licensed physicians, advanced practice nurses (APNs), and physician assistants (PAs) need to apply for an X-waiver from the Substance Abuse and Mental Health Services Administration. 7 Historically, there has been a training requirement to obtain a waiver: 8 hours for physicians and 24 hours for APNs and PAs. As of December 2021, less than 10% of DEA-licensed clinicians were waivered. 8,9 In April 2021, the Biden-Harris administration removed the training requirement to receive a waiver to treat up to 30 patients to expand the number of waivered clinicians, reduce buprenorphine prescribing barriers, and expand buprenorphine access. 10 In this issue of JAMA Network Open, research by Spetz et al 8 and Lanham et al 11 provides important insights into factors influencing buprenorphine prescribing capacity and provision.

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Survey of Barriers and Facilitators to Prescribing Buprenorphine and Clinician Perceptions on the Drug Addiction Treatment Act of 2000 Waiver

Cited by 44 publications

References 31 publications

Buprenorphine Waiver Attitudes Among Primary Care Providers

Buprenorphine Waiver Attitudes Among Primary Care Providers

Effect of Didactic Training on Barriers and Biases to Treatment of Opioid Use Disorder: Meeting the Ongoing Needs of Patients with Opioid Use Disorder in the Emergency Department during the COVID-19 Pandemic

Beyond the Waiver: Multilevel Interventions Needed to Expand Buprenorphine Treatment

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