The Availability of Ancillary Counseling in the Practices of Physicians Prescribing Buprenorphine

Abstract

Objectives We set out to examine physicians’ perceptions of the provision of ancillary services for opioid dependent patients receiving buprenorphine. Methods An email invitation describing the study was sent out by the American Society of Addiction Medicine to its membership (approximately 3,700 physicians) and other entities (for a total of approximately 7,000 email addresses). Email recipients were invited to participate in a research study funded by the National Institutes on Drug Abuse involving completion of an online survey; 346 physicians completed the survey. Results The majority of the 346 respondents were internal or family medicine (37%) or addiction medicine providers (30%) who were practicing in urban (57%) or suburban settings (27%). Most respondents reported either offering (66%) or referring patients for ancillary counseling (31%). Interventions that were most frequently offered or referrals provided were individual counseling (51%) and self-help groups (63%), respectively. Counseling availability differed significantly by provider specialization for any, individual, group, family or couples, and self-help groups. Conclusions Generally, respondents reported compliance with ancillary counseling requirements for buprenorphine treatment of opioid use disorder. In addition to examining the efficacy of a variety of ancillary counseling services for patients receiving opioid agonist treatment, further research should examine physicians’ attitudes toward the role of such counseling in buprenorphine treatment. While the study sample was relatively large, the generalizability of the findings is unclear, suggesting that further investigation of the availability of ancillary counseling in buprenorphine treatment among a larger nationally representative sample of providers may be warranted.

Perceived need and availability of psychosocial interventions across buprenorphine prescriber specialties

“…Prior studies of buprenorphine prescribers have found the majority of prescribers offered counseling within their practice settings and others refer patients to counseling in the community. 7,8 Furthermore, in a small sample of buprenorphine prescribers in New York City, 62% of respondents considered PIs to be of at least high importance for patients. 9 In addition, patients value psychosocial interventions, including brief counseling delivered by the prescriber, though some also believe PIs should not be a mandatory requirement of treatment.…”

Provider Continuity in the Prescribing of Buprenorphine/Naloxone Within Medicare Part D

“…A major issue relating to gaps in treatment capacity are that a minority of providers who would be eligible for the waiver have completed the training, 4,5 amounting to a national median of 5.9 providers per 100,000 patients 6 . Those who have completed the training are more likely to be located in urban areas, places with higher opioid-related mortality, and/or have fewer Medicaid versus private pay patients 4,7–9 . Providers have cited complexity in initiating buprenorphine treatment (including receipt of the waiver), concern over increased regulatory burdens, stigma related to OUD, and other general infrastructure issues as barriers to providing buprenorphine treatment, 5,10–13 and several telementoring projects 14,15 and hub-and-spoke systems 16,17 have been developed to increase willingness to prescribe.…”