title: Analysis of barriers to adoption of buprenorphine maintenance therapy by family physicians.
abstract: BACKGROUND
  Opioid abuse has reached epidemic levels. Evidence-based treatments such as buprenorphine maintenance therapy (BMT) remain underutilized. Offering BMT in primary care settings has the potential to reduce overall costs of care, decrease medical morbidity associated with opioid dependence, and improve treatment outcomes. However, access to BMT, especially in rural areas, remains limited. This article will present a review of barriers to adoption of BMT among family physicians in a primarily rural area in the USA.
  
  
  METHODS
  An anonymous survey of family physicians practicing in Vermont or New Hampshire, two largely rural states, was conducted. The survey included both quantitative and qualitative questions, focused on BMT adoption and physician opinions of opioids. Specific factors assessed included physician factors, physicians' understanding of patient factors, and logistical issues.
  
  
  RESULTS
  One-hundred and eight family physicians completed the survey. Approximately 10% were buprenorphine prescribers. More than 80% of family physicians felt they regularly saw patients addicted to opiates. The majority (70%) felt that they, as family physicians, bore responsibility for treating opiate addiction. Potential logistical barriers to buprenorphine adoption included inadequately trained staff (88%), insufficient time (80%), inadequate office space (49%), and cumbersome regulations (37%). Common themes addressed in open-ended questions included lack of knowledge, time, or interest; mistrust of people with addiction or buprenorphine; and difficult patient population.
  
  
  CONCLUSIONS
  This study aims to quantify perceived barriers to treatment and provide insight expanding the community of family physicians offering BMT. The results suggest family physicians are excellent candidates to provide BMT, as most report regularly seeing opioid-addicted patients and believe that treating opioid addiction is their responsibility. Significant barriers remain, including inadequate staff training, lack of access to addiction experts, and perceived efficacy of BMT. Addressing these barriers may lower resistance to buprenorphine adoption and increase access to BMT in rural areas.
authors: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA. jeffrey.r.deflavio@dartmouth.edu.
authors: Jeffrey R
authors: JR
authors: DeFlavio
authors: Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA. stephanie.a.rolin@dartmouth.edu.
authors: Stephanie A
authors: SA
authors: Rolin
authors: Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA. benjamin.r.nordstrom@hitchcock.org.
authors: Benjamin R
authors: BR
authors: Nordstrom
authors: Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA. louis.a.kazal.jr@dartmouth.edu.
authors: Louis A
authors: LA
authors: Kazal
mesh_terms: D002047:Buprenorphine / Q000008:administration & dosage* / Q000627:therapeutic use; D003219:Confidentiality; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007318:Inservice Training; D008297:Male; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010465:Perception; D010821:Physicians, Family / Q000523:psychology* / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data; D013997:Time Factors; D035502:Trust
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine
keywords: Alcohol and Drug; Epidemiology; Evidence-based Care; General/Family Practice; Health Needs Assessment; Health Service reform; Medical; Mental Health; North America; Primary Health Care; Psychiatry; Public Health; Qualitative Research