Buprenorphine for Opioid Dependence: Why Is It Underprescribed?

Overwhelming evidence has demonstrated that opioid agonist treatment reduces adverse consequences of opioid dependence. To improve access to pharmacotherapy, the Food and Drug Administration approved buprenrophine, a partial μ-opioid agonist, to treat patients with opioid dependence in 2002. To date, however, there has been limited uptake of buprenorphine by physicians, particularly in general practices. In this study, investigators asked 172 physicians involved in 1 of 2 buprenorphine initiatives to complete surveys assessing factors likely to affect their willingness to prescribe buprenorphine. Respondents included 49 trained nonprescribers, 45 novice prescribers (prescribed buprenorphine to 30 or fewer patients), and 78 experienced prescribers.

• Factors rated by all respondents as strongly affecting their willingness to prescribe buprenorphine included:

• lack of clinical training on buprenorphine,
• lack of behavioral health services support (such as substance abuse counseling and mental health services),
• absence of an effective referral system for additional drug treatment,
• lack of adequate time per patient visit,
• limited availability of buprenorphine, and
• concerns about patients on chronic pain medications.

Comments by James Harrison, MHS, CADC
Buprenorphine treatment for opioid abuse and dependence has been on the rise since its introduction in 2002. Yet, surprisingly, only 15% of those needing such treatment receive it. Since this physician survey was limited to those involved in buprenorphine initiatives, it probably provides an underestimate of dissemination barriers. The obstacles listed above suggest systemic drug-treatment education and policy changes are necessary if widespread implementation of office-based buprenorphine treatment is to be fully employed.