Why aren't physicians prescribing more buprenorphine?

Abstract

Background & Objective Buprenorphine is an underutilized pharmacotherapy that can play a key role in combating the opioid epidemic. Individuals with opioid use disorder (OUD) often struggle to find physicians that prescribe buprenorphine. Many physicians do not have the waiver to prescribe buprenorphine, and a large proportion of physicians that are waivered do not prescribe to capacity. This study aimed to quantitatively understand why physicians do not utilize buprenorphine for the treatment of OUD more frequently. Methods Physicians (n=558) with and without the waiver to prescribe buprenorphine were surveyed about perceived drawbacks associated with prescribing buprenorphine. Furthermore, resources were identified that would encourage those without the waiver to obtain it, and those with the waiver to accept more new patients. The survey was distributed online to physicians in the spring/summer of 2016 via the American Society for Addiction Medicine and American Medical Association Listervs. Results and Conclusions A logistic regression analysis was used to identify reasons that respondents indicated no willingness to increase prescribing (2(4) = 73.18, p < .001); main reasons were lack of belief in agonist treatment (or 3.98, 95% CI, 1.43 to 11.1, p = .008), lack of time for additional patients (or 5.54, 95% CI, 3.5 to 8.7, p < .001), and belief that reimbursement rates are insufficient (or 2.50, 95% CI, 1.3 to 4.8, p = .006). Differences between non-waivered and waivered physicians concerning attitudes toward buprenorphine treatment as well as resources that would increase willingness to prescribe are also discussed. Identifying barriers to buprenorphine utilization is crucial in expanding treatment options for individuals with OUD.

Effect of Integrating Substance Use Disorder Treatment into Primary Care on Inpatient and Emergency Department Utilization

“…18 Another study found that non-waivered physicians were more likely to report a lack of belief in the efficacy of buprenorphine, concerns about being overwhelmed by requests for treatment, and a lack of education. 19 This intervention, which provided practices with additional support from the institution in the form of recovery coaches, education, and input from an addiction specialist at bimonthly conferences, was effective at increasing the frequency of prescribing for both buprenorphine and naltrexone.…”

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

“…Despite the substantial growth in the number of providers with a DEA waiver, access to treatment remains difficult for many people, especially those who live in rural areas . Numerous studies show that many waivered physicians are not using their waiver to its full extent or at all, contributing to the lack of treatment access across the country . Providers with a DEA waiver frequently report challenges and barriers to incorporating this service into their practice; however, despite these challenges, many physicians report being able to successfully add and provide MAT services to their practices.…”

“…6 Numerous studies show that many waivered physicians are not using their waiver to its full extent or at all, contributing to the lack of treatment access across the country. [7][8][9] Providers with a DEA waiver frequently report challenges and barriers to incorporating this service into their practice [10][11][12] ; however, despite these challenges, many physicians report being able to successfully add and provide MAT services to their practices. The purpose of this study, to our knowledge the first of its kind, was to identify and interview physicians who are providing MAT to a large number of patients to learn strategies and best practices for adding and providing MAT in rural areas.…”

Implementation of the hub and spoke model for opioid use disorders in California: Rationale, design and anticipated impact

“…As such, one of the priorities of the CA H&S implementation has been to develop a larger cadre of buprenorphine prescribers. Once providers are waivered, they then need more support to promote active and expanded involvement in prescribing buprenorphine for OUD (Huhn & Dunn, 2017;Hutchinson, Catlin, Andrilla, Baldwin, & Rosenblatt, 2014).…”