title: Barriers to primary care physicians prescribing buprenorphine.
abstract: OBJECTIVE
  Despite the efficacy of buprenorphine-naloxone for the treatment of opioid use disorders, few physicians in Washington State use this clinical tool. To address the acute need for this service, a Rural Opioid Addiction Management Project trained 120 Washington physicians in 2010-2011 to use buprenorphine. We conducted this study to determine what proportion of those trained physicians began prescribing this treatment and identify barriers to incorporating this approach into outpatient practice.
  
  
  METHODS
  We interviewed 92 of 120 physicians (77%), obtaining demographic information, current prescribing status, clinic characteristics, and barriers to prescribing buprenorphine. Residents and 7 physicians who were prescribing buprenorphine at the time of the course were excluded from the study. We analyzed the responses of the 78 remaining respondents.
  
  
  RESULTS
  Almost all respondents reported positive attitudes toward buprenorphine, but only 22 (28%) reported prescribing buprenorphine. Most (95%, n = 21) new prescribers were family physicians. Physicians who prescribed buprenorphine were more likely to have partners who had received a waiver to prescribe buprenorphine. A lack of institutional support was associated with not prescribing the medication (P = .04). A lack of mental health and psychosocial support was the most frequently cited barrier by both those who prescribe and who do not prescribe buprenorphine.
  
  
  CONCLUSIONS
  Interventions before and after training are needed to increase the number of physicians who offer buprenorphine for treatment of addiction. Targeting physicians in clinics that agree in advance to institute services, coupled with technical assistance after they have completed their training, their clinical teams, and their administrations is likely to help more physicians become active providers of this highly effective outpatient treatment.
authors.affiliation: University of Washington, Department of Family Medicine, Research Section, Seattle, Washington.
authors.forename: Eliza
authors.initials: E
authors.lastname: Hutchinson
authors.forename: Mary
authors.initials: M
authors.lastname: Catlin
authors.forename: C Holly A
authors.initials: CH
authors.lastname: Andrilla
authors.forename: Laura-Mae
authors.initials: LM
authors.lastname: Baldwin
authors.forename: Roger A
authors.initials: RA
authors.lastname: Rosenblatt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D014861:Washington
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine
keywords: buprenorphine; opiate addiction; opiate substitution treatment; primary health care; rural health