Why aren't physicians prescribing more buprenorphine?

Abstract

Background & objective: Buprenorphine is an underutilized pharmacotherapy that can play a key role in combating the opioid epidemic. Individuals with opioid use disorder (OUD) often struggle to find physicians that prescribe buprenorphine. Many physicians do not have the waiver to prescribe buprenorphine, and a large proportion of physicians that are waivered do not prescribe to capacity. This study aimed to quantitatively understand why physicians do not utilize buprenorphine for the treatment of OUD more frequently.

Methods: Physicians (n=558) with and without the waiver to prescribe buprenorphine were surveyed about perceived drawbacks associated with prescribing buprenorphine. Furthermore, resources were identified that would encourage those without the waiver to obtain it, and those with the waiver to accept more new patients. The survey was distributed online to physicians in the spring/summer of 2016 via the American Society for Addiction Medicine and American Medical Association listservs.

Results and conclusions: A logistic regression analysis was used to identify reasons that respondents indicated no willingness to increase prescribing (χ²(4)=73.18, p<0.001); main reasons were lack of belief in agonist treatment (OR 3.98, 95% CI, 1.43 to 11.1, p=0.008), lack of time for additional patients (OR 5.54, 95% CI, 3.5 to 8.7, p<0.001), and belief that reimbursement rates are insufficient (OR 2.50, 95% CI, 1.3 to 4.8, p=0.006). Differences between non-waivered and waivered physicians concerning attitudes toward buprenorphine treatment as well as resources that would increase willingness to prescribe are also discussed. Identifying barriers to buprenorphine utilization is crucial in expanding treatment options for individuals with OUD.

Keywords: Buprenorphine; Opioid maintenance treatment; Opioid use disorder; Physician.

Figure 1

Bar chart representing median number of patients requesting buprenorphine per month (left panel; open bars) and median number of physician requests that are rejected per month (right panel; gray bars). The distribution of reported requests and rejections is overlaid on the bar chart, with each point corresponding to an individual physician respondent. X-axis represents respondent category (non-waivered, waivered not at capacity, waivered at capacity), and the Yaxis represents approximate number of patients as rated on an ordinal scale. Bonferroni-adjusted pairwise comparisons were used to examine differences between the three respondent categories; *** = p<.001 between a respondent category compared to each of the other two categories.