Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder

The Article in Brief

Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder

C. Holly A. Andrilla , and colleagues

Background Opioid use disorder is a significant public health problem. Buprenorphine is an effective office-based medication-assisted treatment, but 60% of rural counties in the US lack a physician with a Drug Enforcement Agency waiver to prescribe it. This study�s purpose was to understand the barriers faced by waivered physicians who do and don't prescribe buprenorphine.

What This Study Found Rural waivered physicians reported a range of concerns about prescribing buprenorphine including medication misuse, time constraints, and lack of available mental health or psychosocial support services. Waivered physicians who don't currently prescribe buprenorphine or have never done so were more likely than current prescribers to report the following barriers: time constraints, lack of patient need, resistance from practice partners, lack of specialty backup for complex problems, lack of confidence in their ability to manage opioid use disorder, concerns about Drug Enforcement Agency intrusions on their practice, and attraction of drug users to their practice. Physicians reporting other barriers described administrative or infrastructure issues (told they cannot do it, don't have the space or staff), regulatory hurdles (including prior authorization and paperwork), difficult patients, and stigma.

Implications

• The study authors call for tailored strategies to address barriers to providing Buprenorphine Maintenance Treatment and to support physicians in adding or maintaining this service.