Skip to main content

Advertisement

Log in

To Prescribe or Not to Prescribe?: Barriers and Motivators for Progressing Along Each Stage of the Buprenorphine Training and Prescribing Path

  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

This study aimed to identify the strongest barriers and motivators associated with each step toward buprenorphine prescribing (1. obtaining a waiver, 2. beginning to prescribe, and 3. prescribing to more people) among a sample of Missouri-based medical professionals (N = 130). Item weights (number of endorsements times mean rank of the item’s importance) were calculated based on their responses. Across groups, lack of access to psychosocial support services, need for higher levels of care, and clinical complexity were strong barriers. Among non-prescribers (n = 57, 46.3%), administrative burden, potential of becoming an addiction clinic, and concern about misuse and diversion were most heavily weighted. Among prescribers (n = 66, 53.7%), patients’ inability to afford medications was a barrier across phases. Prominent motivators among all groups were the effectiveness of buprenorphine, improvement in other health outcomes, and a personal interest in treating addiction. Only prescribers reported the presence of institutional support and mentors as significant motivators.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

Notes

  1. Not presented at stage 1.

References

  1. National Center for Health Statistics. Provisional drug overdose death counts. Centers for Disease Control and Prevention. Available online at https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2021/20210714.htm. Accessed on November 18, 2021.

  2. Larochelle, M. R., Bernson, D., Land, T., el al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Annals of Internal Medicine. 2018;169(3):137-145.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sordo, L., Barrio, G., Bravo, M. J., et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:1-14.

    Google Scholar 

  4. Wakeman, S. E., Larochelle, M. R., Ameli, O., et al. Comparative effectiveness of different treatment pathways for opioid use disorder. Journal of the American Medical Association Network Open. 2020;3(2):e1920622-e1920622.

    Google Scholar 

  5. Maremmani I, Pani PP, Pacini M, et al. Substance use and quality of life over 12 months among Buprenorphine maintenance-treated and Methadone maintenance-treated Heroin-addicted patients. Journal of Substance Abuse Treatment. 2007; 33(1):91-98.

    Article  PubMed  Google Scholar 

  6. Huhn, A. S., & Dunn, K. E. Why Aren't physicians prescribing more buprenorphine?. Journal of Substance Abuse Treatment. 2017;78: 1-7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Yarborough, B. J. H., Stumbo, S. P., McCarty, D., et al. Methadone, buprenorphine and preferences for opioid agonist treatment: a qualitative analysis. Drug and Alcohol Dependence. 2016;160: 112-118.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Racial Disparities in opioid addiction treatment: primer & research roundup. The Journalist’s Resource. Available online at https://journalistsresource.org/home/systemic-racism-opioid-addiction-treatment/. Accessed on July 14, 2021.

  9. Hansen, H. B., Siegel, C. E., Case, B. G., et al. Variation in use of buprenorphine and methadone treatment by racial, ethnic, and income characteristics of residential social areas in New York City. The Journal of Behavioral Health Services & Research. 2013;40(3): 367–377. https://doi.org/10.1007/s11414-013-9341-3

    Article  Google Scholar 

  10. Biden Administration Finalizes Buprenorphine Practice Guidelines: a step in the right direction. American College of Emergency Physicians. Available online at https://www.acep.org/federal-advocacy/federal-advocacy-overview/regs--eggs/regs--eggs-articles/regs--eggs---april-29-2021/. Accessed on July 14, 2021.

  11. Andrilla, C. H. A., Moore, T. E., Patterson, D. G., et al. Geographic distribution of providers with a DEA waiver to prescribe buprenorphine for the treatment of opioid use disorder: a 5-year update. The Journal of Rural Health. 2019;35(1): 108-112.

    Article  PubMed  Google Scholar 

  12. Duncan, A., Anderman, J., Deseran, T., et al. Monthly patient volumes of buprenorphine-waivered clinicians in the US. Journal of the American Medical Association Network Open. 2020;3(8):e2014045-e2014045.

    Google Scholar 

  13. Thomas, C. P., Doyle, E., Kreiner, P. W., et al. Prescribing patterns of buprenorphine waivered physicians. Drug and Alcohol Dependence. 2017;181:213-218.

    Article  PubMed  Google Scholar 

  14. Wen, H., Hockenberry, J. M., Borders, T. F., et al. Impact of medicaid expansion on medicaid-covered utilization of buprenorphine for opioid use disorder treatment. Medical Care. 2017;55(4):336-341.

    Article  PubMed  Google Scholar 

  15. Hutchinson, E., Catlin, M., Andrilla, C. H. A., et al. Barriers to primary care physicians prescribing buprenorphine. The Annals of Family Medicine. 2014;12(2):128-133.

    Article  PubMed  Google Scholar 

  16. Kermack, A., Flannery, M., Tofighi, B., et al. Buprenorphine prescribing practice trends and attitudes among New York providers. Journal of Substance Abuse Treatment. 2017;74:1-6.

    Article  PubMed  Google Scholar 

  17. Marino, L. A., Campbell, A. N., Nunes, E. V., et al. Factors influencing buprenorphine prescribing among physicians in New York State. Journal of Addiction. 2019;2019:1-5.

    Article  Google Scholar 

  18. Stein, B. D., Gordon, A. J., Dick, A. W., et al. Supply of buprenorphine waivered physicians: the influence of state policies. Journal of Substance Abuse Treatment. 2015;48(1):104-111.

    Article  PubMed  Google Scholar 

  19. Jones, C. M., & McCance-Katz, E. F. Characteristics and prescribing practices of clinicians recently waivered to prescribe buprenorphine for the treatment of opioid use disorder. Addiction. 2019;114(3):471-482.

    Article  PubMed  Google Scholar 

  20. Rural Health Information Hub. What is Rural? Health resources and services administration. Available online at https://www.ruralhealthinfo.org/topics/what-is-rural#goldsmith-modification. Accessed on July 14, 2021.

  21. Andrilla, C. H., Coulthard, C., & Patterson, D. G. Prescribing practices of rural physicians waivered to prescribe buprenorphine. American Journal of Preventive Medicine. 2018;54(6):S208-S214. https://doi.org/10.1016/j.amepre.2018.02.006

    Article  PubMed  Google Scholar 

  22. Haffajee, R. L., Bohnert, A. S., & Lagisetty, P. A. Policy pathways to address provider workforce barriers to buprenorphine treatment. American Journal of Preventive Medicine. 2018;54(6):S230-S242.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Bhatraju, E.P., Grossman, E., Tofighi, B., et al. Public sector low threshold office-based buprenorphine treatment: outcomes at year 7. Addiction Science & Clinical Practice. 2017; 12:7.

    Article  Google Scholar 

  24. Presnall, N. J., Wolf, D. P. S., Brown, D. S., et al. A comparison of buprenorphine and psychosocial treatment outcomes in psychosocial and medical settings. Journal of Substance Abuse Treatment. 2019;104:135-143.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Rice, D., Corace, K., Wolfe, D., et al. Evaluating comparative effectiveness of psychosocial interventions adjunctive to opioid agonist therapy for opioid use disorder: a systematic review with network meta-analyses. PLOS ONE. 2020;15(12): e0244401.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. James, K., & Jordan, A. The opioid crisis in black communities. Journal of Law, Medicine & Ethics. 2018;46(2):404–421. https://doi.org/10.1177/1073110518782949

    Article  Google Scholar 

  27. Steinberg, J., Azofeifa, A., & Sigounas, G. Mobilizing primary care to address the opioid use disorder treatment gap. Public Health Reports. 2019;134(5):456-460.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cicero, T. J., Ellis, M. S., & Chilcoat, H. D. Understanding the use of diverted Buprenorphine. Drug and Alcohol Dependence. 2018;193:117-123.

    Article  PubMed  Google Scholar 

  29. Clark, B., Kai, M., Dix, R., et al. Association of a multimodal educational intervention for primary care physicians with prescriptions of buprenorphine for opioid use disorders. Journal of the American Medical Association Network Open. 2019;2(10):e1913818-e1913818.

    Google Scholar 

  30. Banks, D. E., Carpenter, R. W., Wood, C. A., et al. Commentary on Furr-Holden et al.: As opioid overdose deaths accelerate among Black Americans, COVID-19 widens inequities—a critical need to invest in community-based approaches. Addiction. 2021;116(3):686-687.

Download references

Funding

Funding for this research was provided by the Substance Abuse and Mental Health Services Administration (Grant number 1H79TI081697).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rachel P. Winograd PhD.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix A Barriers and motivators presented in the survey

Appendix A Barriers and motivators presented in the survey

Barriers as presented (for all three stages)

  1. 1.

    Lack of access to higher levels of care for patients who need it

  2. 2.

    Utilization management requirements for buprenorphine (e.g. prior authorizations)

  3. 3.

    Lack of access to psychosocial support for patients

  4. 4.

    Patients cannot afford the medication

  5. 5.

    Patients cannot access the medication from a pharmacy

  6. 6.

    Lack of patient demand

  7. 7.

    Concern about buprenorphine misuse or diversion

  8. 8.

    The idea of substituting one addiction for another

  9. 9.

    Resistance from practice partners or leadership

  10. 10.

    Concern about DEA involvement or punishment

  11. 11.

    Potential for my practice turning into an addiction clinic

  12. 12.

    Administrative burden (e.g., tracking patient slots, 42 CFR)

  13. 13.

    Clinical complexity (induction, co-occurring disorders, etc.)

  14. 14.

    Federally established patient limits (30, 100, 275)Footnote 1

  15. 15.

    Other (please specify)

Motivators as presented (for all three stages)

  1. 1.

    Addiction treatment training or education

  2. 2.

    High or increased reimbursement rates

  3. 3.

    Institutional support for treating addiction

  4. 4.

    Personal interest in treating addiction

  5. 5.

    Effectiveness of buprenorphine for OUD

  6. 6.

    Desire to incorporate more innovations into my practice

  7. 7.

    Managing OUD improves other health outcomes

  8. 8.

    Mandate from leadership

  9. 9.

    Desire to be more competitive on the job market

  10. 10.

    Providing OUD treatment is rewarding

  11. 11.

    Staff support to relieve administrative burden

  12. 12.

    Straightforward treatment protocol

  13. 13.

    Presence of mentors or experienced colleagues

  14. 14.

    Financial compensation for my time spent taking the waiver training

  15. 15.

    Other (please specify)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Winograd, R.P., Coffey, B., Woolfolk, C. et al. To Prescribe or Not to Prescribe?: Barriers and Motivators for Progressing Along Each Stage of the Buprenorphine Training and Prescribing Path. J Behav Health Serv Res 50, 165–180 (2023). https://doi.org/10.1007/s11414-021-09783-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11414-021-09783-z

Keywords

Navigation