Even After Training, Many Primary Care Physicians are Reluctant to Prescribe Buprenorphine

Buprenorphine has been shown to be an effective treatment for opioid use disorder, even when prescribed by primary care physicians without additional psychosocial services. In 2009, the Rural Opioid Management Project was established to train physicians to prescribe buprenorphine in rural areas of Washington State with high opioid death rates and few waivered physicians. Of 120 physicians who completed the training, 92 were interviewed at least 7 months following their training and 78 were included in this study.

• Of the 78 physicians, 50 (64%) had obtained the requisite DEA waiver to prescribe buprenorphine, but only 22 (28%) had since prescribed the medication.
• Family physicians were more likely than other specialties to prescribe buprenorphine (33% versus 7%). Having another physician with a waiver in the practice was associated with prescribing buprenorphine.
• Perceived barriers to prescribing buprenorphine included: lack of mental health and psychosocial support, time constraints, lack of confidence, resistance from practice partners, and lack of institutional support.

Comments:

This study shows that simply providing the required waiver training is not sufficient to overcome barriers to increasing access to buprenorphine treatment. Physicians need institutional support and encouragement. Moreover, the widespread expectation that all patients who are prescribed buprenorphine must also receive psychosocial support beyond standard physician counseling presents another barrier to treatment. Including experience with prescribing buprenorphine in residency training programs may also help.

Darius A. Rastegar, MD

Reference:

Hutchinson E, Catlin M, Andrilla CH, et al. Barriers to primary care physicians prescribing buprenorphine. Ann Fam Med. 2014;12:128–133.