Experiences of a National Sample of Qualified Addiction Specialists Who Have and Have Not Prescribed Buprenorphine for Opioid Dependence

Abstract

The limited availability of medication-assisted treatment has created a treatment gap leaving many opioid dependent individuals without access to appropriate treatment. Survey data from a national random sample of 545 addictions physicians with waivers to provide buprenorphine treatment under The Drug Addiction Treatment Act of 2000 are presented. During the first year, an estimated 63,204 opioid dependent patients were treated with buprenorphine; many were dependent on prescription opioids and were new to drug treatment. Prescribing physicians reported high treatment effectiveness and patient satisfaction, with minimal adverse reactions or evidence of diversion. However, many waivered physicians had not provided buprenorphine treatment. Prescribers identified challenges such as induction logistics, recordkeeping requirements, the 30-patient limit, DEA involvement, and limited patient compliance. Buprenorphine treatment could potentially reduce the treatment gap by providing safe and effective treatment for opioid dependence and by attracting patients who do not typically seek care at opioid treatment programs.

Barriers to Obtaining Waivers to Prescribe Buprenorphine for Opioid Addiction Treatment Among HIV Physicians

“…Despite the fact that methadone maintenance treatment slots are available for only 20% of the 1.7 million opioiddependent Americans, 12,13 physicians have been slow to prescribe buprenorphine for opioid addiction treatment. 14 In one study of addiction specialist physicians (who had buprenorphine waivers), only 58% had ever prescribed buprenorphine, and one quarter of them reported that they reduced or discontinued prescribing it. 14 There are a number of potential reasons for this slow uptake at both the health care system and physician-level.…”

“…14 In one study of addiction specialist physicians (who had buprenorphine waivers), only 58% had ever prescribed buprenorphine, and one quarter of them reported that they reduced or discontinued prescribing it. 14 There are a number of potential reasons for this slow uptake at both the health care system and physician-level. The Drug Addiction Treatment Act of 2000 requires physicians who prescribe buprenorphine to obtain a waiver and obtain a special X number from the Drug Enforcement Agency (DEA).…”

“…[15][16][17][18][19] Previous studies have identified important provider-level barriers to prescribing buprenorphine, including lack of education, training, experience, time, support, and patient compliance; high level of patient complexity; and concern about buprenorphine abuse. 14,16,[20][21][22][23] Of the studies that have examined barriers to prescribing buprenorphine, only one has examined barriers experienced specifically by HIV physicians, 21 who may be particularly well positioned to treat opioid dependence in the course of routine medical care. Sites providing HIV care frequently offer multidisciplinary care, and have supportive services such as social workers, mental health providers, and even substance abuse counselors available.…”

The Supply of Physicians Waivered to Prescribe Buprenorphine for Opioid Use Disorders in the United States: A State-Level Analysis

“…Information regarding buprenorphine waivers is maintained in the Drug Enforcement Agency's Controlled Substances Act (CSA) Registrants database. In the fi rst year after FDA approval, about 2,000 physicians applied for the buprenorphine waiver (Kissin et al, 2006), which had increased to more than 20,000 physicians holding the waiver by 2011 (Stein et al, 2015).…”

“…Considerable work has examined its diffusion in SUD treatment programs and OTPs (Brigham et al, 2007;Ducharme & Abraham, 2008;Ducharme et al, 2007;Friedmann et al, 2010;Gordon et al, 2007;Knudsen et al, 2006Knudsen et al, , 2009Koch et al, 2006;Kovas et al, 2007;Wallack et al, 2010). Several surveys of physicians have examined the nexus between attitudes and prescribing (Arfken et al, 2010;Kissin et al, 2006;Netherland et al, 2009;Reif et al, 2007;Thomas et al, 2008;WESTAT, 2006).…”