TY - JOUR
KW - Buprenorphine/therapeutic use
KW - Cross-Sectional Studies
KW - Data Collection
KW - Humans
KW - Massachusetts
KW - Narcotic Antagonists/therapeutic use
KW - Opioid-Related Disorders/drug therapy
KW - Physicians, Family
KW - Practice Patterns, Physicians'
KW - Private Practice
KW - Psychiatry
AU - A . Y. Walley
AU - J. K. Alperen
AU - D. M. Cheng
AU - M. Botticelli
AU - C. Castro-Donlan
AU - J. H. Samet
AU - D. P. Alford
A1 - 
AB - BACKGROUND: Buprenorphine is a safe, effective and underutilized treatment for opioid dependence that requires special credentialing, known as a waiver, to prescribe in the United States. OBJECTIVE: To describe buprenorphine clinical practices and barriers among office-based physicians. DESIGN: Cross-sectional survey. PARTICIPANTS: Two hundred thirty-five office-based physicians waivered to prescribe buprenorphine in Massachusetts. MEASUREMENTS: Questionnaires mailed to all waivered physicians in Massachusetts in October and November 2005 included questions on medical specialty, practice setting, clinical practices, and barriers to prescribing. Logistic regression analyses were used to identify factors associated with prescribing. RESULTS: Prescribers were 66% of respondents and prescribed to a median of ten patients. Clinical practices included mandatory counseling (79%), drug screening (82%), observed induction (57%), linkage to methadone maintenance (40%), and storing buprenorphine notes separate from other medical records (33%). Most non-prescribers (54%) reported they would prescribe if barriers were reduced. Being a primary care physician compared to a psychiatrist (AOR: 3.02; 95% CI: 1.48-6.18) and solo practice only compared to group practice (AOR: 3.01; 95% CI: 1.23-7.35) were associated with prescribing, while reporting low patient demand (AOR: 0.043, 95% CI: 0.009-0.21) and insufficient institutional support (AOR: 0.37; 95% CI: 0.15-0.89) were associated with not prescribing. CONCLUSIONS: Capacity for increased buprenorphine prescribing exists among physicians who have already obtained a waiver to prescribe. Increased efforts to link waivered physicians with opioid-dependent patients and initiatives to improve institutional support may mitigate barriers to buprenorphine treatment. Several guideline-driven practices have been widely adopted, such as adjunctive counseling and monitoring patients with drug screening.
BT - Journal of general internal medicine
C5 - Opioids & Substance Use
CP - 9
CY - United States
DO - 10.1007/s11606-008-0686-x
IS - 9
JF - Journal of general internal medicine
N2 - BACKGROUND: Buprenorphine is a safe, effective and underutilized treatment for opioid dependence that requires special credentialing, known as a waiver, to prescribe in the United States. OBJECTIVE: To describe buprenorphine clinical practices and barriers among office-based physicians. DESIGN: Cross-sectional survey. PARTICIPANTS: Two hundred thirty-five office-based physicians waivered to prescribe buprenorphine in Massachusetts. MEASUREMENTS: Questionnaires mailed to all waivered physicians in Massachusetts in October and November 2005 included questions on medical specialty, practice setting, clinical practices, and barriers to prescribing. Logistic regression analyses were used to identify factors associated with prescribing. RESULTS: Prescribers were 66% of respondents and prescribed to a median of ten patients. Clinical practices included mandatory counseling (79%), drug screening (82%), observed induction (57%), linkage to methadone maintenance (40%), and storing buprenorphine notes separate from other medical records (33%). Most non-prescribers (54%) reported they would prescribe if barriers were reduced. Being a primary care physician compared to a psychiatrist (AOR: 3.02; 95% CI: 1.48-6.18) and solo practice only compared to group practice (AOR: 3.01; 95% CI: 1.23-7.35) were associated with prescribing, while reporting low patient demand (AOR: 0.043, 95% CI: 0.009-0.21) and insufficient institutional support (AOR: 0.37; 95% CI: 0.15-0.89) were associated with not prescribing. CONCLUSIONS: Capacity for increased buprenorphine prescribing exists among physicians who have already obtained a waiver to prescribe. Increased efforts to link waivered physicians with opioid-dependent patients and initiatives to improve institutional support may mitigate barriers to buprenorphine treatment. Several guideline-driven practices have been widely adopted, such as adjunctive counseling and monitoring patients with drug screening.
PP - United States
PY - 2008
SN - 1525-1497; 0884-8734
SP - 1393
EP - 1398
EP - 
T1 - Office-based management of opioid dependence with buprenorphine: Clinical practices and barriers
T2 - Journal of general internal medicine
TI - Office-based management of opioid dependence with buprenorphine: Clinical practices and barriers
U1 - Opioids & Substance Use
U2 - 18592319
U3 - 10.1007/s11606-008-0686-x
VL - 23
VO - 1525-1497; 0884-8734
Y1 - 2008
ER -