Buprenorphine for Opioid Dependence: Why Is It Underprescribed?
Overwhelming evidence has demonstrated that opioid agonist treatment reduces adverse consequences of opioid dependence. To improve access to pharmacotherapy, the Food and Drug Administration approved buprenorphine, a partial μ-opioid agonist, to treat patients with opioid dependence in 2002. To date, however, there has been limited uptake of buprenorphine by physicians, particularly in general practices. In this study, investigators asked 172 physicians involved in 1 of 2 buprenorphine initiatives to complete surveys assessing factors likely to affect their willingness to prescribe buprenorphine. Respondents included 49 trained nonprescribers, 45 novice prescribers (prescribed buprenorphine to 30 or fewer patients), and 78 experienced prescribers.
- Factors rated by all respondents as strongly affecting their willingness to prescribe buprenorphine included
- lack of clinical training on buprenorphine,
- lack of behavioral health services support (such as substance abuse counseling and mental health services),
- absence of an effective referral system for additional drug treatment,
- lack of adequate time per patient visit,
- limited availability of buprenorphine, and
- concerns about patients on chronic pain medications.
- Experienced prescribers were less concerned than novice or nonprescribers about most factors, particularly induction logistics, access to consultation with a buprenorphine expert, and access to clinical guidelines.
- Experienced prescribers were more concerned than novice or nonprescribers about reimbursement.
Comments:These data indicate that experience prescribing buprenorphine alleviates many associated concerns. Similarities in responses between novice and nonprescribers suggest that substantial experience is required before these concerns are significantly reduced. The desire for guidelines, expert support, and expanded training in this area is not surprising given the limited attention paid to drug addiction and treatment in medical school and residency training curricula. Julia H. Arnsten, MD, MPH
Netherland J, Botsko M, Egan J, et al. Factors affecting willingness to provide buprenorphine treatment. J Subst Abuse Treat. 2008 [Epub ahead of print].