| Peer-Reviewed

Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County

Received: 8 April 2019     Accepted: 27 May 2019     Published: 26 June 2019
Views:       Downloads:
Abstract

Buprenorphine is an effective treatment for opioid use disorder (OUD). Despite the demonstrated efficacy of Medication Assisted Treatment (MAT), few healthcare providers are licensed to prescribe Buprenorphine for OUD. The purpose of this study was to assess the attitudes and prescribing practices of providers licensed to treat patients Buprenorphine in two counties in Northern California. We aim to identify barriers to prescribing Buprenorphine for OUD. This is a descriptive study to understand provider practices, attitudes, and barriers towards Buprenorphine prescribing. Of the 95 x-waivered providers identified in Sacramento and El Dorado County, 36 (38%) responded to our phone survey. 12 (33%) were women, and the three most common specialties were Family Medicine 19 (53%), Addiction Medicine 8 (22%), and Psychiatry 8 (22%). Of the survey participants, 33 (92%) actively prescribe Buprenorphine. Self-motivation was cited as the most common reason to become x-waivered 29 (81%), while the least cited reason was an institutional requirement 3 (8%). The most common motivations for prescribing Buprenorphine included low overdose potential 30 (91%), drug efficacy 28 (85%), and low abuse potential 27 (82%). The greatest barriers to Buprenorphine prescribing included poor reimbursement 15 (46%), time constraints 13 (39%), and patient preference for opiates 11 (33%). Overall, most of the interviewed providers 30 (83%) believed Buprenorphine should be prescribed more frequently to manage addiction or pain. This study found that the majority of x-waivered providers in Sacramento and El Dorado Counties do prescribe Buprenorphine but not at their full capacity.

Published in American Journal of Internal Medicine (Volume 7, Issue 3)
DOI 10.11648/j.ajim.20190703.13
Page(s) 66-71
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Buprenorphine, X-waiver, Opioid Epidemic, Addiction, Dependency

References
[1] Opioid Overdose. (2018, October 19). Retrieved January 05, 2019, from https://www.cdc.gov/drugoverdose/
[2] Drug Overdose Deaths. (2018). Retrieved from http://www.countyhealthrankings.org/app/california/2016/measure/factors/138/data?sort=sc-0
[3] Quality for NP and PA waivers. (2016, November 21). Qualify for NP and PA Waivers. Retrieved from https://www.samhsa.gov/medication-assisted-treatment/training-materials-resources/qualify-np-pa-waivers
[4] Jones, H. E. (2004). Practical Consideration for the Clinical Use of Buprenorphine. Science & Practice Perspectives, 2 (2), 4-20. doi:10.1151/spp04224
[5] Kermack, A., Flannery, M., Tofighi, B., Mcneely, J., & Lee, J. D. (2017). Buprenorphine prescribing practice trends and attitudes among New York providers. Journal of Substance Abuse Treatment, 74, 1-6. doi:10.1016/j.jsat.2016.10.005
[6] Hutchinson, E., Catlin, M., Andrilla, C. H., Baldwin, L., & Rosenblatt, R. A. (2014). Barriers to Primary Care Physicians Prescribing Buprenorphine. The Annals of Family Medicine, 12(2), 128-133. doi:10.1370/afm.1595
[7] Malinoff, H. L., Barkin, R. L., & Wilson, G. (2005). Sublingual Buprenorphine Is Effective in the Treatment of Chronic Pain Syndrome. American Journal of Therapeutics, 12(5), 379-384. doi:10.1097/01.mjt.0000160935.62883.ff
[8] Daitch, D., Daitch, J., Novinson, D., Frey, M., Mitnick, C., & Pergolizzi, J. (2014). Conversion from High-Dose Full-Opioid Agonists to Sublingual Buprenorphine Reduces Pain Scores and Improves Quality of Life for Chronic Pain Patients. Pain Medicine, 15 (12), 2087-2094. doi:10.1111/pme.12520
[9] Rosen, K., Gutierrez, A., Haller, D., & Potter, J. S. (2014, April). Sublingual Buprenorphine for Chronic Pain. The Clinical Journal of Pain, 30 (4), 295-300. doi:10.1097/ajp.0b013e318298ddad
[10] Chen, K. Y., Chen, L., & Mao, J. (2014). Buprenorphine-Naloxone Therapy in Pain Management. Survey of Anesthesiology, 58 (5), 259-260. doi:10.1097/01.sa.0000452828.37555.a3
[11] Koppert, W., Ihmsen, H., Körber, N., Wehrfritz, A., Sittl, R., Schmelz, M., & Schüttler, J. (2005, November). Different profiles of buprenorphine-induced analgesia and antihyperalgesia in a human pain model. Pain, 118 (1), 15-22. doi:10.1016/j. pain.2005.06.030
[12] Thomas, C. P., Doyle, E., Kreiner, P. W., Jones, C. M., Dubenitz, J., Horan, A., & Stein, B. D. (2017, December). Prescribing patterns of buprenorphine waivered physicians. Drug and Alcohol Dependence, 181, 213-218. doi:10.1016/j. drugalcdep.2017.10.002
[13] Jones, C. M., Campopiano, M., Baldwin, G., & Mccance-Katz, E. (2015, August). National and State Treatment Need and Capacity for Opioid Agonist Medication-Assisted Treatment. American Journal of Public Health, 105 (8), 55-63. doi:10.2105/ajph.2015.302664
[14] Huhn, A. S., & Dunn, K. E. (2017, July). Why aren't physicians prescribing more buprenorphine? Journal of Substance Abuse Treatment, 78, 1-7. doi:10.1016/j. jsat.2017.04.005
[15] Kunins, H. V., Sohler, N. L., Giovanniello, A., Thompson, D., & Cunningham, C. O. (2013). A Buprenorphine Education and Training Program for Primary Care Residents: Implementation and Evaluation. Substance Abuse, 34 (3), 242-247. doi:10.1080/08897077.2012.752777
[16] Walley, A. Y., Alperen, J. K., Cheng, D. M., Botticelli, M., Castro-Donlan, C., Samet, J. H., & Alford, D. P. (2008). Office-Based Management of Opioid Dependence with Buprenorphine: Clinical Practices and Barriers. Journal of General Internal Medicine, 23 (9), 1393-1398. doi:10.1007/s11606-008-0686-x
[17] Dick, A. W., Pacula, R. L., Gordon, A. J., Sorbero, M., Burns, R. M., Leslie, D., & Stein, B. D. (2015). Growth In Buprenorphine Waivers For Physicians Increased Potential Access To Opioid Agonist Treatment, 2002–11. Health Affairs, 34 (6), 1028-1034. doi:10.1377/hlthaff.2014.1205
Cite This Article
  • APA Style

    Alana Freifeld, Neeraj Ramakrishnan, Jose Puglisi, Aimee Moulin, Joshua Elder. (2019). Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County. American Journal of Internal Medicine, 7(3), 66-71. https://doi.org/10.11648/j.ajim.20190703.13

    Copy | Download

    ACS Style

    Alana Freifeld; Neeraj Ramakrishnan; Jose Puglisi; Aimee Moulin; Joshua Elder. Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County. Am. J. Intern. Med. 2019, 7(3), 66-71. doi: 10.11648/j.ajim.20190703.13

    Copy | Download

    AMA Style

    Alana Freifeld, Neeraj Ramakrishnan, Jose Puglisi, Aimee Moulin, Joshua Elder. Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County. Am J Intern Med. 2019;7(3):66-71. doi: 10.11648/j.ajim.20190703.13

    Copy | Download

  • @article{10.11648/j.ajim.20190703.13,
      author = {Alana Freifeld and Neeraj Ramakrishnan and Jose Puglisi and Aimee Moulin and Joshua Elder},
      title = {Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County},
      journal = {American Journal of Internal Medicine},
      volume = {7},
      number = {3},
      pages = {66-71},
      doi = {10.11648/j.ajim.20190703.13},
      url = {https://doi.org/10.11648/j.ajim.20190703.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20190703.13},
      abstract = {Buprenorphine is an effective treatment for opioid use disorder (OUD). Despite the demonstrated efficacy of Medication Assisted Treatment (MAT), few healthcare providers are licensed to prescribe Buprenorphine for OUD. The purpose of this study was to assess the attitudes and prescribing practices of providers licensed to treat patients Buprenorphine in two counties in Northern California. We aim to identify barriers to prescribing Buprenorphine for OUD. This is a descriptive study to understand provider practices, attitudes, and barriers towards Buprenorphine prescribing. Of the 95 x-waivered providers identified in Sacramento and El Dorado County, 36 (38%) responded to our phone survey. 12 (33%) were women, and the three most common specialties were Family Medicine 19 (53%), Addiction Medicine 8 (22%), and Psychiatry 8 (22%). Of the survey participants, 33 (92%) actively prescribe Buprenorphine. Self-motivation was cited as the most common reason to become x-waivered 29 (81%), while the least cited reason was an institutional requirement 3 (8%). The most common motivations for prescribing Buprenorphine included low overdose potential 30 (91%), drug efficacy 28 (85%), and low abuse potential 27 (82%). The greatest barriers to Buprenorphine prescribing included poor reimbursement 15 (46%), time constraints 13 (39%), and patient preference for opiates 11 (33%). Overall, most of the interviewed providers 30 (83%) believed Buprenorphine should be prescribed more frequently to manage addiction or pain. This study found that the majority of x-waivered providers in Sacramento and El Dorado Counties do prescribe Buprenorphine but not at their full capacity.},
     year = {2019}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County
    AU  - Alana Freifeld
    AU  - Neeraj Ramakrishnan
    AU  - Jose Puglisi
    AU  - Aimee Moulin
    AU  - Joshua Elder
    Y1  - 2019/06/26
    PY  - 2019
    N1  - https://doi.org/10.11648/j.ajim.20190703.13
    DO  - 10.11648/j.ajim.20190703.13
    T2  - American Journal of Internal Medicine
    JF  - American Journal of Internal Medicine
    JO  - American Journal of Internal Medicine
    SP  - 66
    EP  - 71
    PB  - Science Publishing Group
    SN  - 2330-4324
    UR  - https://doi.org/10.11648/j.ajim.20190703.13
    AB  - Buprenorphine is an effective treatment for opioid use disorder (OUD). Despite the demonstrated efficacy of Medication Assisted Treatment (MAT), few healthcare providers are licensed to prescribe Buprenorphine for OUD. The purpose of this study was to assess the attitudes and prescribing practices of providers licensed to treat patients Buprenorphine in two counties in Northern California. We aim to identify barriers to prescribing Buprenorphine for OUD. This is a descriptive study to understand provider practices, attitudes, and barriers towards Buprenorphine prescribing. Of the 95 x-waivered providers identified in Sacramento and El Dorado County, 36 (38%) responded to our phone survey. 12 (33%) were women, and the three most common specialties were Family Medicine 19 (53%), Addiction Medicine 8 (22%), and Psychiatry 8 (22%). Of the survey participants, 33 (92%) actively prescribe Buprenorphine. Self-motivation was cited as the most common reason to become x-waivered 29 (81%), while the least cited reason was an institutional requirement 3 (8%). The most common motivations for prescribing Buprenorphine included low overdose potential 30 (91%), drug efficacy 28 (85%), and low abuse potential 27 (82%). The greatest barriers to Buprenorphine prescribing included poor reimbursement 15 (46%), time constraints 13 (39%), and patient preference for opiates 11 (33%). Overall, most of the interviewed providers 30 (83%) believed Buprenorphine should be prescribed more frequently to manage addiction or pain. This study found that the majority of x-waivered providers in Sacramento and El Dorado Counties do prescribe Buprenorphine but not at their full capacity.
    VL  - 7
    IS  - 3
    ER  - 

    Copy | Download

Author Information
  • College of Medicine, California Northstate University, Elk Grove, USA

  • College of Medicine, California Northstate University, Elk Grove, USA

  • College of Medicine, California Northstate University, Elk Grove, USA

  • Department of Emergency Medicine, University of California Davis, Sacramento, USA

  • Department of Emergency Medicine, University of California Davis, Sacramento, USA

  • Sections