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Buprenorphine underutilized despite benefits for treating opioid addiction

Although buprenorphine can play a critical role in fighting the opioid epidemic, not enough physicians are prescribing the medication and many are not willing to increase their use of it, according to a presentation at the 125th Annual Convention of the American Psychological Association.

“Though it was widely believed that allowing physicians to prescribe this drug in a primary care setting would increase the number of patients receiving treatment, the number of physicians adopting this therapy has not kept pace with the magnitude of the opioid epidemic,” Andrew Huhn, PhD, from the department of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, said in a press release.

Although physicians can use buprenorphine to treat opioid addiction in up to 30 patients in the first year and 275 patients in each year following with the appropriate waivers from the Substance Abuse and Mental Health Services Administration, many still don’t prescribe the medication to capacity or at all, according to the release. To determine why buprenorphine is underprescribed, Huhn and colleagues assessed surveys from 558 physicians in the United States that asked them to describe perceived problems associated with prescribing buprenorphine and possible resources that could encourage them to obtain the waiver if they did not have it or accept more new patients if they did.

Of 74 physicians who indicated that they did not have waivers to prescribe buprenorphine, roughly one-third responded that nothing would increase their willingness to get a waiver, according to the press release. Some reasons respondents provided for this were concerns about being overwhelmed with requests from patients for buprenorphine and concerns that patients may resell the drug, according to the release. More than 50% of participants with waivers who were underprescribing the medication responded that nothing would decrease their reluctance to prescribe to capacity. Respondents indicated that they would not increase prescribing because of mistrust in agonist treatment (OR = 3.98; 95% CI, 1.43-11.1), no time for extra patients (OR = 5.54; 95% CI, 3.5-8.7) and concern about insufficient reimbursement rates (OR = 2.5; 95% CI, 1.3-4.8). Physicians responded that resources that may increase their willingness to obtain waivers or stop underprescribing included more information about local counseling resources, additional continuing medical education courses on opioid use disorder and pairing with an experienced provider, according to the release.

“I think the two biggest takeaways from our research are that there are not enough physicians prescribing buprenorphine to meet patient demand, and access to counseling services for patients and mentoring services for physicians would make physicians more likely to take on new patients with opioid use disorder,” Huhn said. – by Savannah Demko

Reference:

Huhn A, et al. “Why don’t physicians with the SAMHSA waiver prescribe buprenorphine to capacity?” Presented at: The 125th Annual Convention of the American Psychological Association; Aug. 3-6, 2017; Washington, D.C.