Buprenorphine prescribing practice trends and attitudes among New York providers

Andrea Kermack, Mara Flannery, Babak Tofighi, Jennifer McNeely, Joshua Lee

Research output: Contribution to journalArticle

Abstract

Buprenorphine office-based opioid maintenance is an increasingly common form of treatment for opioid use disorders. However, total prescribing has not kept pace with the current opioid and overdose epidemic and access remains scarce among the underserved. This study sought to assess current provider attitudes and clinical practices among a targeted sample of primarily New York City public sector buprenorphine prescribers. A cross-sectional online survey purposefully sampled buprenorphine prescribers in NYC with a focus on those serving Medicaid and uninsured patient populations. Expert review of local provider networks, snowball referrals, and in-person networking generated an email list, which received a survey link. A brief 25-question instrument queried provider and practice demographics, prescribing practices including induction approaches and attitudes regarding common hot topics (e.g., buprenorphine diversion, prescriber patient limits, insurance issues, ancillary treatments). Of 132 email invitations, N = 72 respondents completed (n = 64) or partially completed (n = 8) the survey between January and April 2016. Most (79%) were Medicaid providers in non-psychiatric specialties (72%), working in a hospital-based or community general practice (51%), and board-certified in addiction medicine or psychiatry (58%). Practice sizes were generally 100 patients or fewer (71%); many providers (64%) individually prescribed buprenorphine <25% of total practice time to a median 23 patients (mean 31, range 0–102). Unobserved (home) induction for new patients was a common practice: 49% predominantly prescribed unobserved induction; 16% mixed unobserved and observed inductions. Adjunctive psychosocial counseling was routinely recommended (46%) or considered on a case-by-case basis (17%) versus mandated (37%). Medication prior authorization requirements were the highest rated barriers to practice, followed by inadequate clinic space, limited clinic time and/or support staff, and inadequate psychiatric services for dual diagnoses. Buprenorphine diversion was not rated as an important practice barrier. In conclusion, this targeted survey of buprenorphine prescribers in NYC treating primarily underserved populations showed a consistent pattern of part-time prescribing to modest volumes of patients, routine use of unobserved buprenorphine induction, and primarily elective referrals to psychosocial counseling. Barriers to prescribing included prior authorization requirements, lack of clinical resources (space, staff) and psychiatric services. Federal and local efforts to reduce such barriers may improve buprenorphine access among the underserved.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalJournal of Substance Abuse Treatment
Volume74
DOIs
StatePublished - Mar 1 2017

Fingerprint

Buprenorphine
Opioid Analgesics
Medicaid
Psychiatry
Counseling
Referral and Consultation
Dual (Psychiatry) Diagnosis
Public Sector
Vulnerable Populations
Insurance
General Practice
Cross-Sectional Studies
Medicine
Demography
Surveys and Questionnaires

Keywords

  • Attitudes
  • Barriers
  • Buprenorphine
  • Providers

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Phychiatric Mental Health
  • Clinical Psychology
  • Psychiatry and Mental health

Cite this

Buprenorphine prescribing practice trends and attitudes among New York providers. / Kermack, Andrea; Flannery, Mara; Tofighi, Babak; McNeely, Jennifer; Lee, Joshua.

In: Journal of Substance Abuse Treatment, Vol. 74, 01.03.2017, p. 1-6.

Research output: Contribution to journalArticle

Kermack, Andrea ; Flannery, Mara ; Tofighi, Babak ; McNeely, Jennifer ; Lee, Joshua. / Buprenorphine prescribing practice trends and attitudes among New York providers. In: Journal of Substance Abuse Treatment. 2017 ; Vol. 74. pp. 1-6.
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