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Research ArticleOriginal Research

Barriers to Primary Care Physicians Prescribing Buprenorphine

Eliza Hutchinson, Mary Catlin, C. Holly A. Andrilla, Laura-Mae Baldwin and Roger A. Rosenblatt
The Annals of Family Medicine March 2014, 12 (2) 128-133; DOI: https://doi.org/10.1370/afm.1595
Eliza Hutchinson
University of Washington, Department of Family Medicine, Research Section, Seattle, Washington
BA
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Mary Catlin
University of Washington, Department of Family Medicine, Research Section, Seattle, Washington
BSN, MPH
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C. Holly A. Andrilla
University of Washington, Department of Family Medicine, Research Section, Seattle, Washington
MS
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Laura-Mae Baldwin
University of Washington, Department of Family Medicine, Research Section, Seattle, Washington
MD, MPH
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Roger A. Rosenblatt
University of Washington, Department of Family Medicine, Research Section, Seattle, Washington
MD, MPH, MFR
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  • For correspondence: rosenb@uw.edu
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Abstract

PURPOSE Despite the efficacy of buprenorphine-naloxone for the treatment of opioid use disorders, few physicians in Washington State use this clinical tool. To address the acute need for this service, a Rural Opioid Addiction Management Project trained 120 Washington physicians in 2010–2011 to use buprenorphine. We conducted this study to determine what proportion of those trained physicians began prescribing this treatment and identify barriers to incorporating this approach into outpatient practice.

METHODS We interviewed 92 of 120 physicians (77%), obtaining demographic information, current prescribing status, clinic characteristics, and barriers to prescribing buprenorphine. Residents and 7 physicians who were prescribing buprenorphine at the time of the course were excluded from the study. We analyzed the responses of the 78 remaining respondents.

RESULTS Almost all respondents reported positive attitudes toward buprenorphine, but only 22 (28%) reported prescribing buprenorphine. Most (95%, n = 21) new prescribers were family physicians. Physicians who prescribed buprenorphine were more likely to have partners who had received a waiver to prescribe buprenorphine. A lack of institutional support was associated with not prescribing the medication (P = .04). A lack of mental health and psychosocial support was the most frequently cited barrier by both those who prescribe and who do not prescribe buprenorphine.

CONCLUSION Interventions before and after training are needed to increase the number of physicians who offer buprenorphine for treatment of addiction. Targeting physicians in clinics that agree in advance to institute services, coupled with technical assistance after they have completed their training, their clinical teams, and their administrations is likely to help more physicians become active providers of this highly effective outpatient treatment.

  • buprenorphine
  • opiate substitution treatment
  • rural health
  • primary health care
  • opiate addiction
  • Received for publication April 18, 2012.
  • Revision received July 29, 2013.
  • Accepted for publication August 14, 2013.
  • © 2014 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 12 (2)
The Annals of Family Medicine: 12 (2)
Vol. 12, Issue 2
March/April 2014
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Barriers to Primary Care Physicians Prescribing Buprenorphine
Eliza Hutchinson, Mary Catlin, C. Holly A. Andrilla, Laura-Mae Baldwin, Roger A. Rosenblatt
The Annals of Family Medicine Mar 2014, 12 (2) 128-133; DOI: 10.1370/afm.1595

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Barriers to Primary Care Physicians Prescribing Buprenorphine
Eliza Hutchinson, Mary Catlin, C. Holly A. Andrilla, Laura-Mae Baldwin, Roger A. Rosenblatt
The Annals of Family Medicine Mar 2014, 12 (2) 128-133; DOI: 10.1370/afm.1595
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  • Evaluation of a Program Designed to Support Implementation of Prescribing Medication for Treatment of Opioid Use Disorder in Primary Care Practices
  • Barriers and Facilitators to Using a Clinical Decision Support Tool for Opioid Use Disorder in Primary Care
  • Barriers and facilitators for family physicians prescribing opioid agonist therapy in Saskatchewan
  • Increasing Access to Medications for Opioid Use Disorder in Primary Care: Removing the Training Requirement May Not Be Enough
  • Clinician Perceptions About a Decision Support System to Identify and Manage Opioid Use Disorder
  • Use of a Benchmark Tracking Assessment to Support Expansion of Buprenorphine for Treatment of Opioid Use Disorder in Primary Care
  • The Concurrent Initiation of Medications Is Associated with Discontinuation of Buprenorphine Treatment for Opioid Use Disorder
  • The Impact on Future Prescribing Patterns of Opioid Use Disorder (OUD) Education and Waiver Provision During Residency
  • Financing Buprenorphine Treatment in Primary Care: A Microsimulation Model
  • The Value of Treating Opioid Use Disorder in Family Medicine: From the Patient Perspective
  • A Change Management Case Study for Safe Opioid Prescribing and Opioid Use Disorder Treatment
  • Barriers and facilitators to buprenorphine use for opioid agonist treatment: protocol for a scoping review
  • Buprenorphine Provision by Early Career Family Physicians
  • Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder
  • Now is the Time to Address Substance Use Disorders in Primary Care
  • Growth In Buprenorphine Waivers For Physicians Increased Potential Access To Opioid Agonist Treatment, 2002-11
  • Geographic and Specialty Distribution of US Physicians Trained to Treat Opioid Use Disorder
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Subjects

  • Domains of illness & health:
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Keywords

  • buprenorphine
  • opiate substitution treatment
  • rural health
  • primary health care
  • opiate addiction

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