TY - JOUR
KW - barriers
KW - buprenorphine
KW - Comparison
KW - Dual Diagnosis
KW - Methadone
KW - Naltrexone
KW - Physicians
KW - Pregnant
KW - referral
KW - Survey
AU - R. L. Haffajee
AU - B. Andraka-Christou
AU - J. Attermann
AU - A. Cupito
AU - J. Buche
AU - A. J. Beck
A1 - 
AB - BACKGROUND: Evidence 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. METHODS: To 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. RESULTS: Study 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. CONCLUSIONS: Additional 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.
AD - 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.; Department of Health Management & Informatics, University of Central Florida, Orlando, FL, USA. barbara.andraka@ucf.edu.; Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, FL, USA. barbara.andraka@ucf.edu.; the National Council for Behavioral Health, Washington, D.C, 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.; 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.
BT - Substance abuse treatment, prevention, and policy
C5 - Education & Workforce; Financing & Sustainability; Healthcare Policy; Opioids & Substance Use
CP - 1
DO - 10.1186/s13011-020-00312-3
IS - 1
JF - Substance abuse treatment, prevention, and policy
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Evidence 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. METHODS: To 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. RESULTS: Study 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. CONCLUSIONS: Additional 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.
PY - 2020
SN - 1747-597X; 1747-597X
SP - 69
T1 - A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder
T2 - Substance abuse treatment, prevention, and policy
TI - A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder
U1 - Education & Workforce; Financing & Sustainability; Healthcare Policy; Opioids & Substance Use
U2 - 32928272
U3 - 10.1186/s13011-020-00312-3
VL - 15
VO - 1747-597X; 1747-597X
Y1 - 2020
Y2 - Sep 14
ER -