Outcomes of DATA 2000 Certification Trainings for the Provision of Buprenorphine Treatment in the Veterans Health Administration

Abstract

Despite the high numbers of veterans with opioid dependence, few receive pharmacologic treatment for this disorder. The adoption of buprenorphine treatment within the Veterans Health Administration (VHA) has been slow. To expand capacity for buprenorphine treatment, the VHA sponsored two eight-hour credentialing courses for the Drug Addiction Treatment Act of 2000. We sought to describe the outcomes of such training. Following the training sessions, 29 participants (18 physicians) were highly satisfied with course content and affirmed their intention to prescribe buprenorphine; after nine-month follow-up, two physicians were prescribing. We conclude that providing credentialing courses, while popular, did not markedly promote the prescription of buprenorphine.

Growth In Buprenorphine Waivers For Physicians Increased Potential Access To Opioid Agonist Treatment, 2002–11

“…With fewer than 3.5% of office-based U.S. physicians waivered to prescribe buprenorphine, potential access to buprenorphine has not diffused as widely as hoped when it was first introduced,(16, 25, 26, 33), and obtaining opioid agonist treatment remains challenging in large swathes of the country. Many of these areas are in the Midwest, a region of the country in which Medicaid policies facilitating access to opioid agonist therapy have historically been less generous than in other regions of the country, and where there have been fewer policy changes in recent years to enhance such access.…”

“…Not all waivered physicians actively treat patients with buprenorphine,(18, 25, 26) and we do not know which waivered physicians are actively treating patients, or the extent to which the geographical distribution of active waivered physicians differs from non-active physicians. As a result, our approach characterizes potential access to treatment, not actual use.…”

Barriers to Use of Pharmacotherapy for Addiction Disorders and How to Overcome Them

“…Once they are trained, providers should stay current in their pharmacotherapy knowledge by continuing to attend trainings [54]. It is important to keep in mind, however, that although training is necessary to speed implementation of pharmacotherapy, it is not sufficient in changing provider behavior [66, 67]. Combining training with some of the suggestions in the following section may be most effective.…”

“…Ensuring provider access to these champions as well as expert consultants or mentors may help address some of the self-efficacy and referral concerns [32, 44, 53, 62, 66, 72]. Moreover, exposing providers to patients receiving and benefiting from pharmacotherapy may also be beneficial [66].…”

Buprenorphine Prescribing: To Expand or Not to Expand

“…Thus, a higher financial incentive coupled with mandatory enforcement of essential components of safe practice should go along with promoting the expansion of therapy to ensure quality of care. We know that simply getting more physicians certified to prescribe does not necessarily lead to increased prescribing, 62 since the average number of patients for certified prescribers is only 26 out of a theoretical limit of 100, and 25% of physicians with a waiver have never prescribed the medication. 63 In addition, recent estimates indicate the average state has only 8 waivered physicians per 100,000 residents.…”