Impact of Policy Change on Access to Medication for Opioid Use Disorder in Primary Care

Abstract

Objectives:The opioid overdose epidemic is escalating. Increasing access to medications for opioid use disorder in primary care is crucial. The impact of the US Department of Health and Human Services' policy change removing the buprenorphine waiver training requirement on primary care buprenorphine prescribing remains unclear. We aimed to investigate the impact of the policy change on primary care providers' likelihood of applying for a waiver and the current attitudes, practices, and barriers to buprenorphine prescribing in primary care.Methods: We used a cross-sectional survey with embedded educational resources disseminated to primary care providers in a southern US academic health system. We used descriptive statistics to aggregate survey data, logistic regression models to evaluate whether buprenorphine interest and familiarity correlate with clinical characteristics, and a χ 2 test to evaluate the effect of the educational intervention on screening.Results: Of the 54 respondents, 70.4% reported seeing patients with opioid use disorder, but only 11.1% had a waiver to prescribe buprenorphine. Few nonwaivered providers were interested in prescribing, but perceiving buprenorphine to be beneficial to the patient population was associated with interest (adjusted odds ratio 34.7, P < 0.001). Two-thirds of nonwaivered respondents reported the policy change having no impact on their decision to obtain a waiver; however, among interested providers, it increased their likelihood of obtaining a waiver. Barriers to buprenorphine prescribing included lack of clinical experience, clinical capacity, and referral resources. Screening for opioid use disorder did not increase significantly after the survey.Conclusions: Although most primary care providers reported seeing patients with opioid use disorder, interest in prescribing buprenorphine was low and structural barriers remained the dominant obstacles. Providers with a preexisting interest in buprenorphine prescribing reported that removing the training requirement was helpful.

Overdose deaths before and during the COVID-19 pandemic in a US county

“…In both supply and demand, primary care physicians may provide one of the few contacts that patients have with the medical system during a pandemic, either in-office or through tele- or video-medicine, and are therefore positioned to educate, treat, or refer those misusing substances ( 39 ). Recent changes to federal law removing the buprenorphine waiver training requirement to prescribing this drug has the potential for greatly expanding and continuing long-term treatment ( 40 ), especially in rural and underserved areas, but more needs to be done to overcome resistance of non-waivered providers to screen for opioid misuse and to prescribe ( 41 ). Another important issue is that the slow-to-change public and private reimbursements for specialty addiction treatment make it difficult to hire staff when salaries in other businesses are increasing rapidly.…”