Barriers to Buprenorphine Expansion in Ohio: A Time-Elapsed Qualitative Study

Abstract

Buprenorphine partial opioid agonist pharmacotherapy, a key treatment for opioid use disorders (OUDs), is underutilized in the United States. Qualitative interviews, conducted in 2012/2013 and repeated in 2015, identified systemic barriers to providing buprenorphine treatment in Ohio. A representative sample of Ohio's Alcohol, Drug Abuse and Mental Health Services (ADAMHS) county boards (n = 18) was selected based on percentage of OUD admissions, density of buprenorphine prescribers, and county board area population. Boards reported that the barriers to the use of buprenorphine in 2012/2013 included (1) negative attitudes toward the use of buprenorphine among substance use disorder treatment providers; (2) a lack of prescribers; and (3) lack of funding. The 2015 interviews suggested that the lack of prescribers surpassed lack of funding as the main impediment to buprenorphine expansion. Negative provider attitudes were no longer problematic. Concerns about buprenorphine diversion, however, had emerged as a new barrier. This article offers recommendations for future policy efforts to overcome these barriers and expand the use of evidence-based opioid treatments. It highlights the need for payers and policymakers to increase the number of buprenorphine prescribers to make best use of funding available to fight the opioid epidemic.

Buprenorphine in the United States: Motives for abuse, misuse, and diversion

“…These concerns are compounded by buprenorphine's unique ability to be prescribed by primary care providers who are unlikely to be experts in the diagnosis and treatment of OUD. Indeed, evidence suggests many providers are reluctant to prescribe buprenorphine for fear it will be abused (Molfenter et al, 2019).…”

Emergency physician perspectives on initiating buprenorphine/naloxone in the emergency department: A qualitative study

“…to shift favorably with experience as a prescriber. 11,23,24 As such, active prescribers may contribute a unique and important perspective.…”

Increasing rates of buprenorphine diversion in the United States, 2002 to 2019

“…Concerns about buprenorphine diversion remain, including among local public health authorities. 20 Moreover, pharmacists may be inclined to limit buprenorphine dispensing because of recent experiences with opioid overprescribing which resulted in limited trust in prescribers, as well as stigma against people who use drugs. 21 For these reasons, some OUD patients report difficulties in obtaining prescriptions for, and limited access to reliable sources of buprenorphine.…”