Use of buprenorphine for addiction treatment: perspectives of addiction specialists and general psychiatrists.
OBJECTIVE
In 2002 buprenorphine (Suboxone or Subutex) was approved by the U.S. Food and Drug Administration for office-based treatment of opioid addiction. The goal of office-based pharmacotherapy is to bring more opiate-dependent people into treatment and to have more physicians address this problem. This study examined prescribing practices for buprenorphine, including facilitators and barriers, and the organizational settings that facilitate its being incorporated into treatment.


METHODS
Addiction specialists and other psychiatrists in four market areas were surveyed by mail and Internet in fall 2005 to examine prescribing practices for buprenorphine. Respondents included 271 addiction specialists (72% response rate) and 224 psychiatrists who were not listed as addiction specialists but who had patients with addictions in their practice (57% response rate).


RESULTS
Three years after approval of buprenorphine for office-based addiction treatment, nearly 90% of addiction specialists had been approved to prescribe it and two-thirds treated patients with buprenorphine. However, fewer than 10% of non-addiction specialist psychiatrists prescribed it. Regression-adjusted factors predicting prescribing of buprenorphine included support of training and use of buprenorphine by the physician's main affiliated organization, less time in general psychiatry compared with addictions treatment, more time in group practice rather than solo, ten or more opiate-dependent patients, belief that drugs play a large role in addiction treatment, and patient demand.


CONCLUSIONS
Office-based pharmacotherapy offers a promising path to improved access to addictions treatment, but prescribing has expanded little beyond the addiction specialist community.
Thomas
Cindy Parks
CP
Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University, 415 South St., MS035, Waltham, MA 02454-9110, USA. cthomas@brandeis.edu
Reif
Sharon
S
Haq
Sayeda
S
Wallack
Stanley S
SS
Hoyt
Alexander
A
Ritter
Grant A
GA
D001291:Attitude of Health Personnel; D016739:Behavior, Addictive / Q000188:drug therapy*; D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D016017:Odds Ratio; D009293:Opioid-Related Disorders / Q000534:rehabilitation; D011570:Psychiatry; D014481:United States
D009292:Narcotic Antagonists; D002047:Buprenorphine