A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use
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RESEARCH
(2020) 15:69
Open Access
A mixed-method comparison of physicianreported beliefs about and barriers to treatment with medications for opioid use disorder Rebecca L. Haffajee1,2,3,4, Barbara Andraka-Christou5,6* , Jeremy Attermann7, Anna Cupito8, Jessica Buche1,8 and Angela J. Beck1,4,8
Abstract Background: Evidence demonstrates that medications for treating opioid use disorder (MOUD) —namely buprenorphine, methadone, and extended-release naltrexone—are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications. Methods: To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods. Results: Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers—such as a lack of addiction treatment specialists—as additional barriers to prescribing medications to treat OUD. Conclusions: Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications. Keywords: Buprenorphine, Methadone, Naltrexone, Barriers, Physicians, Survey, Comparison, Referral, Dual diagnosis, Pregnant
* Correspondence: [email protected] 5 Department of Health Management & Informatics, University of Central Florida, Orlando, FL, USA 6 Department of Internal Medicine (Secondary Joint Appointment), University of Central Florida, Orlando, FL, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link t
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