Integration of counseling among physicians providing office-based buprenorphine treatment

BACKGROUND: Drug counseling can improve outcomes in office-based buprenorphine treatment. However, medical and behavioral health care systems often operate independently. We investigated how physicians meet the counseling needs of buprenorphine patients. METHODS: We recruited buprenorphine prescribers from states with the highest opioid use prevalence. Using a web-based survey (N=195) and qualitative interviews (N=33), we investigated the provision of counseling, services types/locations, and perceived barriers. RESULTS: Almost all physicians felt that counseling was essential to opioid dependence treatment; the majority required counseling for buprenorphine patients (60% for some, 33% for all). Counseling was provided through differing arrangements including onsite by physician (60%), onsite by staff (45%), offsite through contracted individuals/organizations (17%), referrals (60%), online (4%), and resource lists distribution (40%). Most reported having support-staff to assist with buprenorphine treatment, including NPs (42%), substance-abuse counselors (34%), mental-health providers (31%), LSWs (24%), and PAs/NPs (14%). The most significant barriers to counseling were affordability (mean=6.0/10-pt scale); public (6.1) and private (5.6) insurance restrictions; and lack of patient interest (5.9). Other barriers mentioned were time constraints, concerns about treatment efficacy for other drugs, and stigma. Despite these barriers, physicians overwhelmingly supported the integration of buprenorphine, medical care, and counseling. DISCUSSION: Findings suggest that most physicians value counseling and make efforts to connect buprenorphine patients to behavioral health services. It appears as if a range of strategies are used, some of which are likely more effective than others. Additional research is needed to assess the extent to which patients' access and benefit from these disparate approaches