Overcoming barriers to prescribing buprenorphine for the treatment of opioid use disorder: recommendations from rural physicians

Abstract

Purpose:
The United States is in the midst of a severe opioid use disorder
epidemic. Buprenorphine is an effective office-based treatment that can be
prescribed by physicians, nurse practitioners, and physician assistants with a
Drug Enforcement Administration (DEA) waiver. However, many providers
report barriers that keep them from either getting a DEA waiver or fully using
it. The study team interviewed rural physicians successfully prescribing
buprenorphine to identify strategies for overcoming commonly cited barriers
for providing this service.
Methods:
Interview candidates were randomly selected from a list of rurally
located physicians with a DEA waiver to prescribe buprenorphine who
reported treating high numbers of patients on a 2016 survey. Forty-three rural
physicians, who were prescribing buprenorphine to a high number of patients,
were interviewed about how they overcame prescribing barriers previously
identified in that survey.
Findings:
Interviewed physicians reported numerous ways to overcome common
barriers to providing buprenorphine treatment in rural areas. Key recommendations
included ways to (1) get started and maintain medication-assisted
treatment, (2) minimize DEA intrusion and medication diversion, and (3) address
the lack of mental health providers and stigma surrounding opioid use
disorder (OUD). Overall, physicians found providing this service to be very
rewarding.
Conclusions:
Despite known barriers, rural physicians around the country
have been successful in adding buprenorphine treatment to their practices.
Nonprescribing providers can learn from the strategies used by successful prescribers
to add this service.

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