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.
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Notes
Not presented at stage 1.
References
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.
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.
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.
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.
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.
Huhn, A. S., & Dunn, K. E. Why Aren't physicians prescribing more buprenorphine?. Journal of Substance Abuse Treatment. 2017;78: 1-7.
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.
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.
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
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.
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.
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.
Thomas, C. P., Doyle, E., Kreiner, P. W., et al. Prescribing patterns of buprenorphine waivered physicians. Drug and Alcohol Dependence. 2017;181:213-218.
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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
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.
Cicero, T. J., Ellis, M. S., & Chilcoat, H. D. Understanding the use of diverted Buprenorphine. Drug and Alcohol Dependence. 2018;193:117-123.
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.
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.
Funding
Funding for this research was provided by the Substance Abuse and Mental Health Services Administration (Grant number 1H79TI081697).
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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)
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1.
Lack of access to higher levels of care for patients who need it
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2.
Utilization management requirements for buprenorphine (e.g. prior authorizations)
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3.
Lack of access to psychosocial support for patients
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4.
Patients cannot afford the medication
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5.
Patients cannot access the medication from a pharmacy
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6.
Lack of patient demand
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7.
Concern about buprenorphine misuse or diversion
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8.
The idea of substituting one addiction for another
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9.
Resistance from practice partners or leadership
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10.
Concern about DEA involvement or punishment
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11.
Potential for my practice turning into an addiction clinic
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12.
Administrative burden (e.g., tracking patient slots, 42 CFR)
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13.
Clinical complexity (induction, co-occurring disorders, etc.)
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14.
Federally established patient limits (30, 100, 275)Footnote 1
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15.
Other (please specify)
Motivators as presented (for all three stages)
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1.
Addiction treatment training or education
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2.
High or increased reimbursement rates
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3.
Institutional support for treating addiction
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4.
Personal interest in treating addiction
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5.
Effectiveness of buprenorphine for OUD
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6.
Desire to incorporate more innovations into my practice
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7.
Managing OUD improves other health outcomes
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8.
Mandate from leadership
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9.
Desire to be more competitive on the job market
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10.
Providing OUD treatment is rewarding
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11.
Staff support to relieve administrative burden
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12.
Straightforward treatment protocol
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13.
Presence of mentors or experienced colleagues
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14.
Financial compensation for my time spent taking the waiver training
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15.
Other (please specify)
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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
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DOI: https://doi.org/10.1007/s11414-021-09783-z