Why Are Doctors Underusing Suboxone : an Opioid Treatment Drug?

Methadone, which must be dispensed from authorized clinics under federal law, and buprenorphine, which can be used to treat opioid addiction in the privacy of a physician's office if the physician has the proper waivers, are the two opioid replacement medications currently approved for opioid use disorder.

"Though it was widely assumed that allowing physicians to prescribe this drug in a primary care setting would increase the number of patients receiving treatment, the number of physicians adopting this therapy has not kept pace with the magnitude of the opioid epidemic," according to Andrew Huhn, PhD, of Johns Hopkins University School of Medicine.

Buprenorphine was approved for the treatment of opioid use disorder in 2002, but doctors had to seek for a waiver from the Substance Abuse and Mental Health Services Administration before prescribing it in primary care. Its mechanism of action is comparable to methadone's but less intense, making it less prone to be abused. However, daily doses are sufficient to reduce withdrawal symptoms. Waivers allow physicians to treat up to 30 patients in the first year and 275 patients each year after that.

During the spring and summer of 2016, Huhn and his colleagues conducted an email survey of 558 English-speaking physicians in the United States. Participants were asked about the perceived disadvantages of prescribing buprenorphine, as well as resources that could encourage those who did not have the waiver to get one, and those who did have the waiver to accept more new patients.

Only 74 people said they didn't have the necessary waivers to prescribe the medicine. One-third of those surveyed claimed that nothing would make them more willing to acquire a waiver. Not wanting to be bombarded with patient requests for buprenorphine (29.7%) and concerns about patients reselling their prescription were the most common reasons for not obtaining a waiver (25.7 percent).

Nothing, according to more than half of respondents with waivers who were not prescribing to capacity, would make them more likely to prescribe at that level. The most common causes for not prescribing at full capacity were a lack of time (36 percent) and inadequate reimbursement (15.4 percent).

Overall, survey respondents indicated that receiving information about local counseling resources, being paired with an experienced provider, and receiving more continuing medical education courses on opioid use disorder were the resources most likely to increase their willingness to obtain waivers or prescribe to capacity.

In 2014, 1.27 million people were hospitalized or sought help at an emergency department for opioid-related disorders, according to government data released earlier this year. This represents a 64 percent rise in in-patient care and a 99 percent increase in emergency room visits compared to 2005.

"I believe the two most important takeaways from our research are that there aren't enough physicians prescribing buprenorphine to meet patient demand, and that access to patient counseling and physician mentoring would encourage physicians to take on new patients with opioid use disorder," Huhn said.

"Why Don't Physicians with the SAMHSA Waiver Prescribe Buprenorphine to Capacity?" is the topic of Session 1239. Room 207B, Level 2, Walter E. Washington Convention Center, 801 Mount Vernon Pl., N.W., Washington, D.C., 1-1:50 p.m. EDT, Thursday, Aug. 3, 1-1:50 p.m. EDT, Paper Session, Room 207B, Level 2, Walter E. Washington Convention Center, 801 Mount Vernon Pl., N.W., Washington, D.C.

The APA Public Affairs Office has presentations available.

Andrew Huhn can be reached at (410) 550-1971 or by email.

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