title: A qualitative study of the adoption of buprenorphine for opioid addiction treatment.
abstract: Qualified physicians may prescribe buprenorphine to treat opioid dependence, but medication use remains controversial. We examined adoption of buprenorphine in two not-for-profit integrated health plans, over time, completing 101 semi-structured interviews with clinicians and clinician-administrators from primary and specialty care. Transcripts were reviewed, coded, and analyzed. A strong leader championing the new treatment was critical for adoption in both health plans. Once clinicians began using buprenorphine, patients' and other clinicians' experiences affected decisions more than did the champion. With experience, protocols developed to manage unsuccessful patients and changed to support maintenance rather than detoxification. Diffusion outside addiction and mental health settings was nonexistent; primary care clinicians cited scope-of-practice issues and referred patients to specialty care. With greater diffusion came questions about long-term use and safety. Recognizing how implementation processes develop may suggest where, when, and how to best expend resources to increase adoption of such treatments.
authors.affiliation: Kaiser Permanente Center for Health Research; 3800N. Interstate Avenue, Portland, OR 97227-1110. Electronic address: carla.a.green@kpchr.org.
authors.forename: Carla A
authors.initials: CA
authors.lastname: Green
authors.affiliation: Dept. of Public Health & Preventive Medicine, Oregon Health & Science University; 3181S.W. Sam Jackson Hill Road, CB 669, Portland, OR 97239. Electronic address: mccartyd@ohsu.edu.
authors.forename: Dennis
authors.initials: D
authors.lastname: McCarty
authors.affiliation: Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612. Electronic address: jennifer.mertens@kp.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mertens
authors.affiliation: Kaiser Permanente Center for Health Research; 3800N. Interstate Avenue, Portland, OR 97227-1110. Electronic address: frances.lynch@kpchr.org.
authors.forename: Frances L
authors.initials: FL
authors.lastname: Lynch
authors.affiliation: University of Hawaii, Dept. of Psychiatry, 1356 Lusitana Ave, 4th floor, Honolulu, HI 96813. Electronic address: hildea@dop.hawaii.edu.
authors.forename: Anadam
authors.initials: A
authors.lastname: Hilde
authors.affiliation: Kaiser Permanente Center for Health Research; 3800N. Interstate Avenue, Portland, OR 97227-1110. Electronic address: alison.j.firemark@kpchr.org.
authors.forename: Alison
authors.initials: A
authors.lastname: Firemark
authors.affiliation: Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612. Electronic address: constance.weisner@kp.org.
authors.forename: Constance M
authors.initials: CM
authors.lastname: Weisner
authors.affiliation: Kaiser Permanente Chemical Dependency Recovery Program1201 Fillmore StreetSan Francisco, CA 94115. Electronic address: david.pating@kp.org.
authors.forename: David
authors.initials: D
authors.lastname: Pating
authors.affiliation: Kaiser Permanente Northwest, Addiction Medicine Department, 3550N. Interstate Avenue, Portland, OR 97227-1097. Electronic address: bradley.m.anderson@kp.org.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Anderson
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use*; D005069:Evaluation Studies as Topic; D006801:Humans; D009293:Opioid-Related Disorders / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine
keywords: Buprenorphine; Diffusion of technology; Implementation research; Medication adoption; Opioid addiction; Qualitative research