Stigma apparent in physician replies to survey on buprenorphine prescribing

Results of a physician survey presented at last week's annual convention of the American Psychological Association (APA) offer some disappointing news about persistent stigma around addiction, but also some hope around the role specialty providers could play in counteracting it.

The surveyed doctors who reported not being waivered to prescribe buprenorphine said their two biggest reasons for not pursuing a waiver were not wanting to be inundated with patient requests for the drug and having concerns about patients reselling the medication. “They don't want to be known as a buprenorphine doc,” says Andrew Huhn, PhD, a postdoctoral fellow at the Johns Hopkins University School of Medicine, referring to the 74 out of 558 surveyed physicians who were not waivered to prescribe the medication to treat opioid dependence.

However, the survey also found that the resources that would most improve doctors' willingness to become waivered, or that would make waivered doctors more likely to prescribe to their full capacity, include receiving information about local counseling resources, being paired with an experienced provider, and receiving more education around opioid use disorders. This conveys to Huhn that if specialty providers could help to build care networks of professionals willing to deliver medication treatment and counseling, more physicians would step up their prescribing.

The physicians were surveyed via e-mail in the spring and summer of last year, and the survey results have been published in the Journal of Substance Abuse Treatment. Huhn tells Addiction Professional that the surveyed doctors' names came from American Medical Association (AMA) and American Society of Addiction Medicine (ASAM) listserv data.

Some won't budge

Among the physicians who reported not having a waiver to prescribe buprenorphine, around one-third said nothing would increase their willingness to do so. By comparison, among the waivered physicians who were not prescribing to capacity, more than half said nothing could be done to increase their willingness to take on more buprenorphine patients.

The reasons doctors most frequently cited for not prescribing to capacity were not having time for more patients and receiving insufficient reimbursement, in that order.

“What's surprising is how many patients are turned away every month,” says Huhn, even in practices where physician retain capacity to serve more patients.

Huhn points out that while some physicians continue to resist becoming buprenorphine prescribers, “This doesn't mean they're not seeing patients with addictions. They're just not treating the disease,” but instead are treating some of its manifestations without getting at the underlying problem.

He does see some reasons for optimism, including the newfound ability of nurse practitioners and physician assistants to have a direct impact on improving office-based prescribing rates, as well as the enacted increase in the maximum number of patients that an individual physician may treat