A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder

Substance Abuse Treatment, Prevention, and Policy

Anna Cupito¹  Barbara Andraka-Christou²  Jessica Buche³  Angela J. Beck⁴  Rebecca L. Haffajee⁵  Jeremy Attermann⁶ 

[1] Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA;Department of Health Management & Informatics, University of Central Florida, Orlando, FL, USA;Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, FL, USA;From the Behavioral Health Workforce Research Center, University of Michigan, Ann Arbor, MI, USA;Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA;From the Behavioral Health Workforce Research Center, University of Michigan, Ann Arbor, MI, USA;Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA;Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA;From the Behavioral Health Workforce Research Center, University of Michigan, Ann Arbor, MI, USA;RAND Corporation, Boston, MA, USA;Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MA, USA;Injury Prevention Center, Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA;the National Council for Behavioral Health, Washington, D.C, USA;

关键词: Buprenorphine;    Methadone;    Naltrexone;    Barriers;    Physicians;    Survey;    Comparison;    Referral;    Dual diagnosis;    Pregnant;   

DOI  :  10.1186/s13011-020-00312-3

来源: Springer

【 摘 要 】

BackgroundEvidence demonstrates that medications for treating opioid use disorder (MOUD) —namely buprenorphine, methadone, and extended-release naltrexone—are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications.MethodsTo understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods.ResultsStudy findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers—such as a lack of addiction treatment specialists—as additional barriers to prescribing medications to treat OUD.ConclusionsAdditional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications.

【 授权许可】

CC BY