Buprenorphine Prescribing Availability in a Sample of Ohio Specialty Treatment Organizations

Abstract

Objective Buprenorphine, a medication for treating opioid dependence, is underutilized in specialty addiction treatment organizations. Only physicians who have obtained a buprenorphine prescribing license or “waiver” may administer this medication. A limited number of physicians are pursuing this waiver, and a concern in the substance use disorder treatment field is that the shortage of prescribers could be contributing to the low use of buprenorphine at specialty addiction treatment centers. The objective of this study is to assess Ohio specialty treatment organizations’ access to buprenorphine prescribers and the barriers they encounter when seeking new physician prescribing capacity. Methods Forty-one Ohio specialty addiction treatment organizations were invited to complete a survey of their buprenorphine practices and availability of buprenorphine prescribers during August–October 2014. Data was collected on pharmacotherapies used in the treatment of opioid dependence, arrangements treatment organizations have with prescribing physicians, buprenorphine prescribing capacity, and barriers encountered in recruiting new physician prescribers. Results Thirty-seven treatment organizations responded, for a response rate of 90.2%. Seventy-eight percent (n=29) of the sample provided buprenorphine therapy. Of those treatment organizations, 48.3% (n=14) reported insufficient prescribing capacity. Of those, 50% (n=7) indicated they had to turn patients away from buprenorphine therapy due to limited physician prescribing capacity. Conclusion The study suggests that buprenorphine use is constrained by limited physician prescribing capacity, to the degree that 24.1% of the organizations surveyed using buprenorphine therapy had to turn patients away. Potential remedies include encouraging more specialty treatment organizations to have physicians on staff, removing the Drug Addiction Treatment Act (DATA 2000) cap that limits physician buprenorphine caseloads at 100 patients (after year 1), and developing strategies to recruit physicians into addiction treatment practice. Additional research is needed to increase the knowledge of physician prescribing capacity as a barrier to buprenorphine use, how to overcome these barriers, and to understand the extent physician capacity shortages are affecting buprenorphine use.

Buprenorphine physician supply: Relationship with state-level prescription opioid mortality

“…Recent work to expand buprenorphine in Massachusetts through technical assistance and the employment of nurse care managers in community health centers has shown promise (LaBelle et al, 2016) and may be beneficial in other states. Research on implementation strategies to increase the likelihood that physicians begin prescribing buprenorphine to opioid-dependent patients is still needed throughout the US (Ducharme et al, 2016; Molfenter et al, 2015; Ober et al, 2015), but our findings suggest the need for strategies to promote buprenorphine adoption is particularly acute outside the Northeast.…”

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

“…Prescribers' low buprenorphine adoption rates reflect concerns about reimbursement (Netherland et al 2009), the requirement for DATA 2000 training and associated DEA oversight (Molfenter et al 2015a), a fear of being inundated with buprenorphine requests (Huhn and Dunn 2017), and concerns about diversion of buprenorphine for non-prescription use (Huhn and Dunn 2017). The low adoption rate prompted an investigation of barriers that inhibited routine use of buprenorphine as an opioid agonist therapy in Ohio.…”

Building medication for opioid use disorder prescriber capacity during the opioid epidemic: Prescriber recruitment trends and methods

“…Early in the medication for opioid use disorder (MOUD) adoption diffusion trajectory, many SUD clinics with physician addiction specialists or psychiatrists already on staff converted their willing and available providers into MOUD prescribers ( Molfenter et al, 2015 ). However, since 58.8 % of SUD clinics in 2002–2004 did not have a doctor on staff during the early onset of use of buprenorphine ( Knudsen et al, 2007 ), the need to expand prescribing capacity emerged in SUD clinics wanting to provide this MOUD.…”