Factors affecting willingness to provide buprenorphine treatment

The New York Academy of Medicine, Division of Health Policy, New York, NY 10029, USA.
Journal of substance abuse treatment (Impact Factor: 2.9). 09/2008; 36(3):244-51. DOI: 10.1016/j.jsat.2008.06.006
Source: PubMed


Buprenorphine is an effective long-term opioid agonist treatment. As the only pharmacological treatment for opioid dependence readily available in office-based settings, buprenorphine may facilitate a historic shift in addiction treatment from treatment facilities to general medical practices. Although many patients have benefited from the availability of buprenorphine in the United States, almost half of current prescribers are addiction specialists suggesting that buprenorphine treatment has not yet fully penetrated general practice settings. We examined factors affecting willingness to offer buprenorphine treatment among physicians with different levels of prescribing experience. Based on their prescribing practices, physicians were classified as experienced, novice, or as a nonprescriber and asked to assess the extent to which a list of factors impacted their prescription of buprenorphine. Several factors affected willingness to prescribe buprenorphine for all physicians: staff training; access to counseling and alternate treatment; visit time; buprenorphine availability; and pain medications concerns. Compared with other physicians, experienced prescribers were less concerned about induction logistics and access to expert consultation, clinical guidelines, and mental health services. They were more concerned with reimbursement. These data provide important insight into physician concerns about buprenorphine and have implications for practice, education, and policy change that may effectively support widespread adoption of buprenorphine.

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Available from: Chinazo O Cunningham, Jan 06, 2014
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    • "An alarming number of methadone clinics have waitlists, due in part to inadequate public funding, unfavorable zoning regulations and requirements for comprehensive care that increase their cost (Des Jarlais, Paone, Friedman, Peyser, & Newman, 1995; Fountain, Strang, Griffiths, Powis, & Gossop, 2000; Gryczynski, Schwartz, O'Grady, & Jaffe, 2009; Peles, Schreiber, Sason, & Adelson, 2012; Peles, Schreiber, & Adelson, 2013; Peterson et al., 2010). Many areas also lack office-based buprenorphine treatment capacity due to barriers to obtaining the special federal certification needed for prescribing buprenorphine, physicians' concerns about induction logistics, reimbursement challenges, potential for medication nonadherence or diversion, and challenges in delivering psychosocial services to patients (Barry et al., 2008; Becker & Fiellin, 2006; Kissin, McLeod, Sonnefeld, & Stanton, 2006; Netherland et al., 2009; Sigmon, 2015). Taken together, opioid-dependent individuals can remain on waitlists for months and are at significant risk for illicit drug use, criminal activity, infectious disease and mortality during this delay to treatment (Adamson & Sellman, 1998; Clausen et al., 2009; Cooper, 1989; Darke & Hall, 2003; Schwartz et al., 2009; Schwartz et al., 2009; Schwartz, Kelly, O'Grady, Gandhi, & Jaffe, 2011; Warner-Smith, Darke, Lynskey, & Hall, 2001; Wenger & Rosenbaum, 1994). "
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    ABSTRACT: Despite the effectiveness of agonist maintenance for opioid dependence, individuals can remain on waitlists for months, during which they are at significant risk for morbidity and mortality. Interim dosing, consisting of daily medication without counseling, can reduce these risks. In this pilot study, we examined the initial feasibility of a novel technology-assisted interim buprenorphine treatment for waitlisted opioid-dependent adults. Following buprenorphine induction during Week 1, participants (n=10) visited the clinic at Weeks 2, 4, 6, 8, 10 and 12 to ingest their medication under staff observation, provide a urine specimen and receive their remaining doses via a computerized Med-O-Wheel Secure device. They also received daily monitoring via an Interactive Voice Response (IVR) platform, as well as random call-backs for urinalysis and medication adherence checks. The primary outcome was percent of participants negative for illicit opioids at each 2-week visit, with secondary outcomes of past-month drug use, adherence and acceptability. Participants achieved high levels of illicit opioid abstinence, with 90% abstinent at the Week 2 and 4 visits and 60% at Week 12. Significant reductions were observed in self-reported past-month illicit opioid use (p<.001), opioid withdrawal (p<.001), opioid craving (p<.001) and ASI Drug composite score (p=.008). Finally, adherence with buprenorphine administration (99%), daily IVR calls (97%) and random call-backs (82%) was high. Interim buprenorphine treatment shows promise for reducing patient and societal risks during delays to conventional treatment. A larger-scale, randomized clinical trial is underway to more rigorously examine the efficacy of this treatment approach. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Addictive behaviors 07/2015; 51:136-142. DOI:10.1016/j.addbeh.2015.07.030 · 2.76 Impact Factor
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    • "Those individuals who have lower education , are unemployed, live in metropolitan areas or who are on probation or parole have higher rates of substance dependence or abuse (SAMHSA, 2011) and many FQHCs serving these individuals strive to deliver comprehensive and integrated healthcare including mental health services. Nevertheless, despite the capability of primary care physicians (PCPs) to prescribe buprenorphine, barriers persist that prevent expansion of buprenorphine maintenance treatment (BMT; Barry et al., 2009; Netherland et al., 2009). Aside from efficacy trials conducted in primary care settings, few studies examine the relative effectiveness of BMT that is provided "
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    ABSTRACT: Background: Few studies have examined real-world effectiveness of integrated buprenorphine maintenance treatment (BMT) programs in federally qualified health centers (FQHCs). Methods: Opioid dependent patients (N=266) inducted on buprenorphine between July 2007 and December 2008 were retrospectively assessed at Connecticut's largest FQHC network. Six-month BMT retention and opioid-free time were collected longitudinally from electronic health records; 136 (51.1%) of patients were followed for at least 12 months. Results: Participants had a mean age of 40.1 years, were primarily male (69.2%) and treated by family practitioners (70.3%). Co-morbidity included HCV infection (59.8%), mood disorders (71.8%) and concomitant cocaine use (59%). Retention on BMT was 56.8% at 6 months and 61.6% at 12 months for the subset observed over 1 year. Not being retained on BMT at 12 months was associated with cocaine use (AOR=2.18; 95% CI=1.35-3.50) while prescription of psychiatric medication (AOR=0.36; 95% CI 0.20-0.62) and receiving on-site substance abuse counseling (AOR=0.34; 95% CI 0.19, 0.59) improved retention. Two thirds of the participants experienced at least one BMT gap of 2 or more weeks with a mean gap length of 116.4 days. Conclusions: Integrating BMT in this large FQHC network resulted in retention rates similarly reported in clinical trials and emphasizes the need for providing substance abuse counseling and screening for and treating psychiatric comorbidity.
    Drug and alcohol dependence 01/2013; 131(1-2). DOI:10.1016/j.drugalcdep.2012.12.008 · 3.42 Impact Factor
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    • "In response to the poor uptake of innovations such as new medications, preliminary studies are beginning to examine the agency level or program factors that impact adoption. In terms of buprenorphine, early research suggests that organizational characteristics including access to a physician on staff or contract (Knudsen et al., 2009), accreditation (Knudsen et al., 2007), a larger size (Ducharme & Roman, 2009), having a hospital affiliation (Knudsen et al., 2007), involvement in research (Ducharme & Roman, 2009), offering detoxification services (Koch, Arfken, & Schuster, 2006; Knudsen et al., 2009), leadership that promotes the use of buprenorphine (Friedmann, Jiang, & Alexander, 2010; Wallack, Thomas, Martin, Chilingerian, & Reif, 2010) and experience with the medication (Ducharme, Knudsen, & Roman, 2007; Netherland et al., 2009) all appear to increase the likelihood of adoption of buprenorphine. "
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    ABSTRACT: Despite evidence that buprenorphine is effective and safe and offers greater access as compared with methadone, implementation for treatment of opiate dependence continues to be weak. Research indicates that legal and regulatory factors, state policies, and organizational and provider variables affect adoption of buprenorphine. This study uses hierarchical linear modeling to examine National Treatment Center Study data to identify counselor characteristics (attitudes, training, and beliefs) and organizational factors (accreditation, caseload, access to buprenorphine, and other evidence-based practices) that influence implementation of buprenorphine for treatment of opiate dependence. Analyses showed that provider training about buprenorphine, higher prevalence of opiate-dependent clients, and less treatment program emphasis on a 12-step model predicted greater counselor acceptance and perceived effectiveness of buprenorphine. Results also indicate that program use of buprenorphine for any treatment purpose (detoxification, maintenance, and/or pain management) and time (calendar year in data collection) was associated with increased diffusion of knowledge about buprenorphine among counselors and with more favorable counselor attitudes toward buprenorphine.
    Journal of substance abuse treatment 08/2011; 41(4):374-85. DOI:10.1016/j.jsat.2011.05.005 · 2.90 Impact Factor
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