番茄社区

WASHINGTON -- Physicians need more education and support to meet national patient demand for prescribing buprenorphine to treat opioid use disorder, a Johns Hopkins School of Medicine researcher said here, reporting findings from a study showing how and why they don't prescribe the medication to their "capacity."

Only about 40% of the 558 physicians surveyed online last year reported prescribing buprenorphine to capacity (defined as prescribing for 30 patients during the first year of being waivered and 100 patients thereafter). Researchers found statistically significant correlations between physicians' unwillingness to write prescriptions, or write more of them, and these attitudes:

• They did not believe in agonist treatment
• They lacked the time to see more patients
• They viewed reimbursement rates as being insufficient

The study identified 272 physicians who had secured a waiver needed to write buprenorphine prescriptions but were not prescribing to capacity, and 54.8% of them said "nothing" would make them more likely to prescribe. They "expressed concern with practical barriers associated with buprenorphine treatment, such as appropriate reimbursement for services and actual time capacity," the authors wrote in a published in Journal of Substance Abuse Treatment.

Among the 74 respondents who had not secured the waiver, one-third said nothing would make them more likely to prescribe the drug. In addition, about 30% said they did not seek the waiver because they did not want to be inundated with requests, while a similar proportion were concerned about medication diversion. These physicians overall "expressed negative attitudes toward buprenorphine treatment," the authors wrote.

"These data suggest that increasing the number of waivered physicians without making additional resources available to combat infrastructure concerns," they wrote, "is unlikely to have a large impact on buprenorphine prescribing."

"This study shows the majority of patient requests for treatment are being rejected," lead author Andrew Huhn, PhD, of Johns Hopkins, told 番茄社区 after his presentation at the .

"I found that disheartening," he added. "It's a conversation you've got to have with your patients: What are the patient's needs?"

Respondents cited "resources most likely to increase their willingness to either become waivered or prescribe to capacity," the authors wrote, which "were receiving information about local counseling resources, being paired with an experienced provider, and receiving more CME courses on OUD (opioid use disorder)." Those resources coincided with previous studies.

Huhn called for more CME, medical school training and other provider education about OUD, as well as public outreach "to reduce the stigma" around it.

Primary care physicians "can really play a key role" in enhancing nationwide treatment, he added, noting that many are already interfacing with opioid-addicted patients -- as opposed to specialists, who decline to see such patients. "The challenge is just getting people into treatment," whatever that means, he said. "We know not every doctor will prescribe this drug."

Huhn's team sought "to provide insight to the medical community and inform public policy regarding approaches that might increase adoption and prescribing of buprenorphine," they wrote, via a 15-item survey.

More than one-third of the respondents practiced in the southern U.S. states, which Huhn called a "geographic disparity." One-third were addiction medicine specialists, while one-quarter were psychiatrists and 18% family medicine physicians.

In addition to the geographic disparity, the authors reported study limitations including under-representation of non-waivered physicians and over-representation of addiction specialists. They also administered a brief survey and used a convenience sample, limited to fluent English speakers.

Huhn's presentation and the article follow a June vote by the AMA's House of Delegates to develop and publicize a microsite advising practitioners on buprenorphine, but the House declined to call for elimination of the waiver regulation.

Huhn's team is now developing an article about patient perspectives, he said, and hopes to follow up on providers' opinions as well, to ultimately drive policy governing treatment of OUD and other substance abuse disorders.

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