Impact of research network participation on the adoption of buprenorphine for substance abuse treatment

Abstract

There is a growing body of research supporting the use of buprenorphine and other medication assisted treatments (MATs) for the rapidly accelerating opioid epidemic in the United States. Despite numerous advantages of buprenorphine (accessible in primary care, no daily dosing required, minimal stigma), implementation has been slow. As the field progresses, there is a need to understand the impact of participation in practitioner-scientist research networks on acceptance and uptake of buprenorphine. This paper examines the impact of research network participation on counselor attitudes toward buprenorphine addressing both counselor-level characteristics and program-level variables using hierarchical linear modeling (HLM) to account for nesting of counselors within treatment programs. Using data from the National Treatment Center Study, this project compares privately funded treatment programs (n=345) versus programs affiliated with the National Institute on Drug Abuse Clinical Trials Network (CTN) (n=198). Models included 922 counselors in 172 CTN programs and 1,203 counselors in 251 private programs. Results of two-level HLM logistic (Bernoulli) models revealed that counselors with higher levels of education, larger caseloads, more buprenorphine-specific training, and less preference for 12-step treatment models were more likely to perceive buprenorphine as acceptable and effective. Furthermore, buprenorphine was 50% more likely to be perceived as effective among counselors working in CTN-affiliated programs as compared to private programs. This study suggests that research network affiliation positively impacts counselors’ acceptance and perceptions of buprenorphine. Thus, research network participation can be utilized as a means to promote positive attitudes toward the implementation of innovations including medication assisted treatment.

Safety and Efficacy of Lofexidine for Medically Managed Opioid Withdrawal: A Randomized Controlled Clinical Trial

“…Although methadone and buprenorphine are effective OATs for management of OUD, they are controlled substances with limitations that include restricted access and availability (Sharma et al, 2017), potential for misuse and diversion (Soyka, 2014), and barriers to acceptability in certain arenas, such as criminal justice settings (Nunn et al, 2009). These treatments have also been discouraged and stigmatized among some patient subpopulations, including those involved in 12-step mutual help programs (Frank, 2011; Rieckmann et al, 2014). Furthermore, patients may have residual symptoms during initiation of OAT or during agonist-assisted withdrawal, and may benefit from augmentation (Diaper et al, 2014), and augmentation with an α 2 -adrenergic agonist has been used to prolong abstinence in buprenorphine-maintained patients with a putative mechanism of amelioration of stress-induced relapse, consistent with its mechanism as a sympatholytic (Kowalczyk et al, 2015).…”

Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration

“…Prior studies of buprenorphine dissemination have suggested that early buprenorphine clinical trials, with their support for staff training, provided the infrastructure for subsequent general adoption in those public hospitals that hosted trials (Rieckmann et al, 2014). We could not address this issue, as we lacked the data on which VHA facilities participated in such clinical trials.…”

Effects of Regulation on Methadone and Buprenorphine Provision in the Wake of Hurricane Sandy

“…Stronger networks of buprenorphine providers have eased buprenorphine dispense in the past and can help improve the continuity of care for buprenorphine patients who are displaced from their primary clinic. 15 Such networks promise not only to enhanced cross-coverage during routine and emergency service disruptions, but also to address a widespread concern among current and potential buprenorphine prescribers about the lack of professional support and mentoring available to prescribers in managing buprenorphine patients. 16 During Hurricane Sandy, providers depended on the prescribing capabilities of residents and fellows, and credentialing delays for these trainees became increasingly cumbersome for continuity of care of patients at host hospitals.…”