21 Sep Fewer Physicians Than Anticipated Treat Opioid Use Disorder With Buprenorphine
MedicalResearch.com Interview with:
Bradley D. Stein, MD, MPH, PhD
University of Pittsburgh School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The United States is in the midst of a serious opioid abuse epidemic and we know that medically assisted treatment is one of the best ways to help people with addiction to opioids. The drug buprenorphine has advantages over methadone, the historic medical treatment, because it can be prescribed by physicians in the community who receive a waiver allowing them to prescribe it after undergoing eight hours of training.. Methadone is dispensed at special clinics that many people with opioid addition may be unable to get to with the frequency required by effective treatment.
To better understand patterns of the use of buprenorphine, we examined treatment patterns in the states with the most buprenorphine-waivered physicians (California, Florida, Massachusetts, Michigan, New York, Pennsylvania and Texas). Our data came from a prescription records that account for over 80 percent of the retail pharmacies in the nation. We examined use patterns among 3,200 physicians who treated 250,000 patients.
We had two surprising findings:
First, the median length of treatment with buprenorphine was 53 days, which is much shorter than the duration that most individuals are likely to need for optimal results. Second, despite concerns that federal limits on the number of patients and waivered physician can treat being a significant barrier for many individuals obtaining treatment, we found that most physicians were treating far fewer patients than would be allowed by the patient limits. In fact, 22 percent of the physicians treated an average of 3 patients per month and just 9 percent treated 75 or more patients per month.
MedicalResearch.com: What should readers take away from your report?
Response: There is a significant opportunity to increase the nation’s health care system’s capacity to provide medical treatment for opioid addiction, an approach that is one of the foundations for the federal government’s response to the opioid epidemic, just through a modest increase in the number of patients physicians currently prescribing buprenorphine are treating. Such efforts would be an important complement to recent federal initiatives to raise the patient cap and increase the number of individuals waivered to prescribe buprenorphine. In addition, it appears that many people who received buprenorphine for opioid addition receive treatment for less time than is generally recommended. Much more work is needed to make sure high-quality medical treatment is available to people who are addicted to opioids
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: More work needs to be done to better understand the use of medical treatment for opioid addition, with an eye on how to expand use of buprenorphine. Novice prescribers cite insufficient access to more-experienced prescribers and insufficient access to substance abuse counseling for patients as barriers to treating more patients. We need to better understand these barriers and how to address them. We also need to keep a close eye on the quality of care being provided to individuals with opioid use disorders to ensure that the treatment being provided is likely to result in the best clinical outcomes for these individuals.
MedicalResearch.com: Is there anything else you would like to add?
Response: One limitation of our study is that we cannot exclude the possibility that
buprenorphine was prescribed off-label for pain and not to treat opioid addiction.
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Stein BD, Sorbero M, Dick AW, Pacula R, Burns RM, Gordon AJ. Physician Capacity to Treat Opioid Use Disorder With Buprenorphine-Assisted Treatment. JAMA.2016;316(11):1211-1212. doi:10.1001/jama.2016.10542.
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