title: Office-based management of opioid dependence with buprenorphine: clinical practices and barriers.
abstract: 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.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Two hundred thirty-five office-based physicians waivered to prescribe buprenorphine in Massachusetts.
  
  
  METHODS
  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.
authors.affiliation: Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA 02118, USA. awalley@bu.edu
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Walley
authors.forename: Julie K
authors.initials: JK
authors.lastname: Alperen
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: Michael
authors.initials: M
authors.lastname: Botticelli
authors.forename: Carolyn
authors.initials: C
authors.lastname: Castro-Donlan
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Alford
mesh_terms: D002047:Buprenorphine / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D003625:Data Collection; D006801:Humans; D008404:Massachusetts; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010821:Physicians, Family; D010818:Practice Patterns, Physicians'; D011331:Private Practice; D011570:Psychiatry
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine