Primary Care Providers’ Attitudes on the Removal of Mandatory Training Requirement to Obtain the Buprenorphine Waiver

Context: Medications for Opioid Use Disorder (MOUD), such as buprenorphine, is the standard of care to treat patients with opioid use disorder (OUD).

There is inadequate access to this life-saving treatment in the US; the number of opioid overdoses continues to rise. In order to prescribe buprenorphine to treat OUD, providers need to obtain a ‘waiver’. In April 2021, the mandatory training requirement to obtain the buprenorphine waiver was removed. It is not known if such a measure will entice more primary care providers to apply for the waiver.

Objective: To survey primary care providers on their attitudes towards the removal of the mandatory waiver training requirement, as well as to examine other barriers that may discourage providers in obtaining the waiver.

Study Design & Analysis: A survey was designed to assess four domains related to MOUD: overall beliefs on the effectiveness of MOUD and attitudes towards the removal of mandatory waiver training; current knowledge of buprenorphine; current practice styles related to screening for and treating OUD; and attitudes towards prescribing buprenorphine in the future.

Setting & Population Studied: This survey was sent to 890 primary care providers in Minnesota, Wisconsin, Iowa, Florida and Arizona.

Outcome Measures: Providers’ attitudes toward removal of mandatory buprenorphine waiver training; current knowledge on buprenorphine; current management strategies on screening for and treating OUD patients; and attitudes towards prescribing buprenorphine in the future.

Results: 35.8% respondents agreed that the removal of the mandatory waiver training was a positive step towards OUD treatment. Those that agreed also expressed a greater familiarity with buprenorphine and diagnosing patients with OUD, find treating OUD patients more rewarding, and intend to prescribe buprenorphine in the future. 34.4% respondents reported perceived institutional support in prescribing buprenorphine. This group also expressed greater familiarity with buprenorphine and are more likely to prescribe buprenorphine in the future. Respondents who have been in practice for 11-20 years since completion of training were most likely to refer all OUD patients to specialists.

Conclusions: The majority of primary care respondents did not agree that the removal of the waiver training was a positive step. Other factors, including familiarity with buprenorphine and perceived institutional support, need to be further addressed.