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APHA Scientific Session and Event Listing

Julie Netherland, MSW¹, Michael Botsko, MSW¹, James Egan, MPH¹, Linda Weiss, PhD¹, Chinazo Cunningham, MD², Ruth Finkelstein, ScD¹, Hillary Kunins, MD, MPH², Andrew Saxon, MD³, Nancy Sohler, PhD, MPH⁴, Lynn Sullivan, MD⁵, and David Fiellin, MD⁵. (1) Division of Health Policy, The New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, 212-419-3560, jnetherland@nyam.org, (2) Albert Einstein College of Medicine, Montefiore Medical Center, 111 E. 210th Street, Bronx, NY 10467, (3) Department of Psychiatry and Behavioral Sciences, University of Washington, 1660 S. Columbian Wy, Seattle, WA 98108, (4) Department of Community Health and Social Medicine, City College of New York, 138th Street and Convent Avenue, New York, NY 10031, (5) Yale University School of Medicine, 333 Cedar Street, DCB 013F, POB 208025, New Haven, CT 06520

Background: Despite literature demonstrating buprenorphine's effectiveness in treating opioid dependence, physician adoption of buprenorphine has been relatively slow. We investigate self-reported barriers to prescribing buprenorphine among physicians with varying levels of prescribing experience.

Methods: 159 physicians, drawn from two ongoing initiatives promoting the use of buprenorphine, completed a self-administered survey, including questions about barriers to prescribing buprenorphine. Respondents were grouped as experienced (mentors in a program to support the use of buprenorphine, mean patients/month = 21, N=51); new (at least one patient on buprenorphine, mean patients ever = 10, N=38), or non-prescribers (never prescribed, N=70).

Results: All three groups reported lack of access to supportive services, such as counseling and other drug treatment, as a significant barrier. Compared to experienced and new prescribers, non-prescribers were more likely to report induction logistics (experienced:18% vs. new:22% vs. non:34%, p <.01) and certification requirements (experienced:20% vs. new:21% vs. non:51%, p <.01) as barriers. In contrast, experienced prescribers were more likely than new and non-prescribers to report reimbursement (experienced:61% vs. new:27% vs. non:32%, p<.01) as a key barrier.

Conclusions: These data suggest that perceived barriers to prescribing buprenorphine may change as physicians gain experience. Overcoming perceived barriers will require a range of strategies, including tailoring trainings to the experience level of physicians, improving access to ancillary and supportive services, and promoting policies to ameliorate concerns about reimbursement.

Learning Objectives: At the end of this presentation, participants will be able to

• Identify physicians' barriers to buprenorphine prescription in office-based settings;
• Describe differences in barriers between experienced, new, and non-prescribers; and
• Prioritize educational and other initiatives to address barriers to prescribing buprenorphine among physicians with differing levels of experience.

Keywords: Drug Abuse Treatment, Policy/Policy Development

Related Web page: www.bhives.org

Presenting author's disclosure statement:

Any relevant financial relationships? No