Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County

Alana Freifeld; Neeraj Ramakrishnan; Jose Puglisi; Aimee Moulin; Joshua Elder

doi:doi:10.11648/j.ajim.20190703.13

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Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County

Alana Freifeld, Neeraj Ramakrishnan, Jose Puglisi, Aimee Moulin, Joshua Elder

Published in American Journal of Internal Medicine (Volume 7, Issue 3)

Received: 8 April 2019 Accepted: 27 May 2019 Published: 26 June 2019

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Abstract

Buprenorphine is an effective treatment for opioid use disorder (OUD). Despite the demonstrated efficacy of Medication Assisted Treatment (MAT), few healthcare providers are licensed to prescribe Buprenorphine for OUD. The purpose of this study was to assess the attitudes and prescribing practices of providers licensed to treat patients Buprenorphine in two counties in Northern California. We aim to identify barriers to prescribing Buprenorphine for OUD. This is a descriptive study to understand provider practices, attitudes, and barriers towards Buprenorphine prescribing. Of the 95 x-waivered providers identified in Sacramento and El Dorado County, 36 (38%) responded to our phone survey. 12 (33%) were women, and the three most common specialties were Family Medicine 19 (53%), Addiction Medicine 8 (22%), and Psychiatry 8 (22%). Of the survey participants, 33 (92%) actively prescribe Buprenorphine. Self-motivation was cited as the most common reason to become x-waivered 29 (81%), while the least cited reason was an institutional requirement 3 (8%). The most common motivations for prescribing Buprenorphine included low overdose potential 30 (91%), drug efficacy 28 (85%), and low abuse potential 27 (82%). The greatest barriers to Buprenorphine prescribing included poor reimbursement 15 (46%), time constraints 13 (39%), and patient preference for opiates 11 (33%). Overall, most of the interviewed providers 30 (83%) believed Buprenorphine should be prescribed more frequently to manage addiction or pain. This study found that the majority of x-waivered providers in Sacramento and El Dorado Counties do prescribe Buprenorphine but not at their full capacity.

Published in	American Journal of Internal Medicine (Volume 7, Issue 3)
DOI	10.11648/j.ajim.20190703.13
Page(s)	66-71
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Buprenorphine, X-waiver, Opioid Epidemic, Addiction, Dependency

References

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[4]	Jones, H. E. (2004). Practical Consideration for the Clinical Use of Buprenorphine. Science & Practice Perspectives, 2 (2), 4-20. doi:10.1151/spp04224
[5]	Kermack, A., Flannery, M., Tofighi, B., Mcneely, J., & Lee, J. D. (2017). Buprenorphine prescribing practice trends and attitudes among New York providers. Journal of Substance Abuse Treatment, 74, 1-6. doi:10.1016/j.jsat.2016.10.005
[6]	Hutchinson, E., Catlin, M., Andrilla, C. H., Baldwin, L., & Rosenblatt, R. A. (2014). Barriers to Primary Care Physicians Prescribing Buprenorphine. The Annals of Family Medicine, 12(2), 128-133. doi:10.1370/afm.1595
[7]	Malinoff, H. L., Barkin, R. L., & Wilson, G. (2005). Sublingual Buprenorphine Is Effective in the Treatment of Chronic Pain Syndrome. American Journal of Therapeutics, 12(5), 379-384. doi:10.1097/01.mjt.0000160935.62883.ff
[8]	Daitch, D., Daitch, J., Novinson, D., Frey, M., Mitnick, C., & Pergolizzi, J. (2014). Conversion from High-Dose Full-Opioid Agonists to Sublingual Buprenorphine Reduces Pain Scores and Improves Quality of Life for Chronic Pain Patients. Pain Medicine, 15 (12), 2087-2094. doi:10.1111/pme.12520
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[12]	Thomas, C. P., Doyle, E., Kreiner, P. W., Jones, C. M., Dubenitz, J., Horan, A., & Stein, B. D. (2017, December). Prescribing patterns of buprenorphine waivered physicians. Drug and Alcohol Dependence, 181, 213-218. doi:10.1016/j. drugalcdep.2017.10.002
[13]	Jones, C. M., Campopiano, M., Baldwin, G., & Mccance-Katz, E. (2015, August). National and State Treatment Need and Capacity for Opioid Agonist Medication-Assisted Treatment. American Journal of Public Health, 105 (8), 55-63. doi:10.2105/ajph.2015.302664
[14]	Huhn, A. S., & Dunn, K. E. (2017, July). Why aren't physicians prescribing more buprenorphine? Journal of Substance Abuse Treatment, 78, 1-7. doi:10.1016/j. jsat.2017.04.005
[15]	Kunins, H. V., Sohler, N. L., Giovanniello, A., Thompson, D., & Cunningham, C. O. (2013). A Buprenorphine Education and Training Program for Primary Care Residents: Implementation and Evaluation. Substance Abuse, 34 (3), 242-247. doi:10.1080/08897077.2012.752777
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APA Style

Alana Freifeld, Neeraj Ramakrishnan, Jose Puglisi, Aimee Moulin, Joshua Elder. (2019). Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County. American Journal of Internal Medicine, 7(3), 66-71. https://doi.org/10.11648/j.ajim.20190703.13

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ACS Style

Alana Freifeld; Neeraj Ramakrishnan; Jose Puglisi; Aimee Moulin; Joshua Elder. Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County. Am. J. Intern. Med. 2019, 7(3), 66-71. doi: 10.11648/j.ajim.20190703.13

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AMA Style

Alana Freifeld, Neeraj Ramakrishnan, Jose Puglisi, Aimee Moulin, Joshua Elder. Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County. Am J Intern Med. 2019;7(3):66-71. doi: 10.11648/j.ajim.20190703.13

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@article{10.11648/j.ajim.20190703.13,
  author = {Alana Freifeld and Neeraj Ramakrishnan and Jose Puglisi and Aimee Moulin and Joshua Elder},
  title = {Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County},
  journal = {American Journal of Internal Medicine},
  volume = {7},
  number = {3},
  pages = {66-71},
  doi = {10.11648/j.ajim.20190703.13},
  url = {https://doi.org/10.11648/j.ajim.20190703.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20190703.13},
  abstract = {Buprenorphine is an effective treatment for opioid use disorder (OUD). Despite the demonstrated efficacy of Medication Assisted Treatment (MAT), few healthcare providers are licensed to prescribe Buprenorphine for OUD. The purpose of this study was to assess the attitudes and prescribing practices of providers licensed to treat patients Buprenorphine in two counties in Northern California. We aim to identify barriers to prescribing Buprenorphine for OUD. This is a descriptive study to understand provider practices, attitudes, and barriers towards Buprenorphine prescribing. Of the 95 x-waivered providers identified in Sacramento and El Dorado County, 36 (38%) responded to our phone survey. 12 (33%) were women, and the three most common specialties were Family Medicine 19 (53%), Addiction Medicine 8 (22%), and Psychiatry 8 (22%). Of the survey participants, 33 (92%) actively prescribe Buprenorphine. Self-motivation was cited as the most common reason to become x-waivered 29 (81%), while the least cited reason was an institutional requirement 3 (8%). The most common motivations for prescribing Buprenorphine included low overdose potential 30 (91%), drug efficacy 28 (85%), and low abuse potential 27 (82%). The greatest barriers to Buprenorphine prescribing included poor reimbursement 15 (46%), time constraints 13 (39%), and patient preference for opiates 11 (33%). Overall, most of the interviewed providers 30 (83%) believed Buprenorphine should be prescribed more frequently to manage addiction or pain. This study found that the majority of x-waivered providers in Sacramento and El Dorado Counties do prescribe Buprenorphine but not at their full capacity.},
 year = {2019}
}

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TY - JOUR
T1 - Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County
AU - Alana Freifeld
AU - Neeraj Ramakrishnan
AU - Jose Puglisi
AU - Aimee Moulin
AU - Joshua Elder
Y1 - 2019/06/26
PY - 2019
N1 - https://doi.org/10.11648/j.ajim.20190703.13
DO - 10.11648/j.ajim.20190703.13
T2 - American Journal of Internal Medicine
JF - American Journal of Internal Medicine
JO - American Journal of Internal Medicine
SP - 66
EP - 71
PB - Science Publishing Group
SN - 2330-4324
UR - https://doi.org/10.11648/j.ajim.20190703.13
AB - Buprenorphine is an effective treatment for opioid use disorder (OUD). Despite the demonstrated efficacy of Medication Assisted Treatment (MAT), few healthcare providers are licensed to prescribe Buprenorphine for OUD. The purpose of this study was to assess the attitudes and prescribing practices of providers licensed to treat patients Buprenorphine in two counties in Northern California. We aim to identify barriers to prescribing Buprenorphine for OUD. This is a descriptive study to understand provider practices, attitudes, and barriers towards Buprenorphine prescribing. Of the 95 x-waivered providers identified in Sacramento and El Dorado County, 36 (38%) responded to our phone survey. 12 (33%) were women, and the three most common specialties were Family Medicine 19 (53%), Addiction Medicine 8 (22%), and Psychiatry 8 (22%). Of the survey participants, 33 (92%) actively prescribe Buprenorphine. Self-motivation was cited as the most common reason to become x-waivered 29 (81%), while the least cited reason was an institutional requirement 3 (8%). The most common motivations for prescribing Buprenorphine included low overdose potential 30 (91%), drug efficacy 28 (85%), and low abuse potential 27 (82%). The greatest barriers to Buprenorphine prescribing included poor reimbursement 15 (46%), time constraints 13 (39%), and patient preference for opiates 11 (33%). Overall, most of the interviewed providers 30 (83%) believed Buprenorphine should be prescribed more frequently to manage addiction or pain. This study found that the majority of x-waivered providers in Sacramento and El Dorado Counties do prescribe Buprenorphine but not at their full capacity.
VL - 7
IS - 3
ER -

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Author Information

Alana Freifeld

College of Medicine, California Northstate University, Elk Grove, USA
Neeraj Ramakrishnan

College of Medicine, California Northstate University, Elk Grove, USA
Jose Puglisi

College of Medicine, California Northstate University, Elk Grove, USA
Aimee Moulin

Department of Emergency Medicine, University of California Davis, Sacramento, USA
Joshua Elder

Department of Emergency Medicine, University of California Davis, Sacramento, USA

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APA Style

Alana Freifeld, Neeraj Ramakrishnan, Jose Puglisi, Aimee Moulin, Joshua Elder. (2019). Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County. American Journal of Internal Medicine, 7(3), 66-71. https://doi.org/10.11648/j.ajim.20190703.13

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ACS Style

Alana Freifeld; Neeraj Ramakrishnan; Jose Puglisi; Aimee Moulin; Joshua Elder. Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County. Am. J. Intern. Med. 2019, 7(3), 66-71. doi: 10.11648/j.ajim.20190703.13

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AMA Style

Alana Freifeld, Neeraj Ramakrishnan, Jose Puglisi, Aimee Moulin, Joshua Elder. Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County. Am J Intern Med. 2019;7(3):66-71. doi: 10.11648/j.ajim.20190703.13

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@article{10.11648/j.ajim.20190703.13,
  author = {Alana Freifeld and Neeraj Ramakrishnan and Jose Puglisi and Aimee Moulin and Joshua Elder},
  title = {Factors Limiting Buprenorphine Prescriptions in Sacramento and El Dorado County},
  journal = {American Journal of Internal Medicine},
  volume = {7},
  number = {3},
  pages = {66-71},
  doi = {10.11648/j.ajim.20190703.13},
  url = {https://doi.org/10.11648/j.ajim.20190703.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20190703.13},
  abstract = {Buprenorphine is an effective treatment for opioid use disorder (OUD). Despite the demonstrated efficacy of Medication Assisted Treatment (MAT), few healthcare providers are licensed to prescribe Buprenorphine for OUD. The purpose of this study was to assess the attitudes and prescribing practices of providers licensed to treat patients Buprenorphine in two counties in Northern California. We aim to identify barriers to prescribing Buprenorphine for OUD. This is a descriptive study to understand provider practices, attitudes, and barriers towards Buprenorphine prescribing. Of the 95 x-waivered providers identified in Sacramento and El Dorado County, 36 (38%) responded to our phone survey. 12 (33%) were women, and the three most common specialties were Family Medicine 19 (53%), Addiction Medicine 8 (22%), and Psychiatry 8 (22%). Of the survey participants, 33 (92%) actively prescribe Buprenorphine. Self-motivation was cited as the most common reason to become x-waivered 29 (81%), while the least cited reason was an institutional requirement 3 (8%). The most common motivations for prescribing Buprenorphine included low overdose potential 30 (91%), drug efficacy 28 (85%), and low abuse potential 27 (82%). The greatest barriers to Buprenorphine prescribing included poor reimbursement 15 (46%), time constraints 13 (39%), and patient preference for opiates 11 (33%). Overall, most of the interviewed providers 30 (83%) believed Buprenorphine should be prescribed more frequently to manage addiction or pain. This study found that the majority of x-waivered providers in Sacramento and El Dorado Counties do prescribe Buprenorphine but not at their full capacity.},
 year = {2019}
}

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