Clinical Practice Innovation

Physicians’ Readiness for Office-Based Opioid Treatment in Primary Care

In 2015, more than 12 million Americans reported misuse of a prescription opioid in the past year, but only 10 percent of patients meeting diagnostic criteria for opioid use disorder (OUD) received treatment. In the same year, only 2.2 percent of all physicians met regulatory requirements to prescribe buprenorphine to treat OUD. More than 82 percent of rural counties like those in Western North Carolina (WNC) lacked any physicians who could prescribe this evidence-based medicine.

Researchers at UNC Health Sciences at MAHEC surveyed prescribing (“waivered”) and non-prescribing physicians and residents in a large family medicine teaching practice located in WNC where office-based opioid treatment (OBOT) is available with integrated behavioral healthcare and clinical pharmacy support.

Respondents were asked about their perceptions of OBOT’s value and effectiveness, their experience with OBOT, and readiness to prescribe buprenorphine.

The majority of both prescribing and non-prescribing physicians identified lack of readiness as a barrier to prescribing buprenorphine, a finding supported by previous research.

The study found that physicians who prescribed buprenorphine were significantly more likely than non-prescribing physicians to indicate they understood the needs of patients with OUD and felt prepared to take care of these patients. Of those who felt prepared, having access to an inter-professional team and individual conversations with other prescribers were identified as most helpful.

This study demonstrates the importance of connecting experienced prescribers with non-prescribers and incorporating interdisciplinary teams to increase prescriber readiness for OBOT. The manuscript is currently under review for publication.

More research is needed to ensure generalizability beyond an academic setting and should include physicians in private practice who choose not to prescribe buprenorphine as well as nurse practitioners and physician assistants who are now able to prescribe buprenorphine after completing approved training.

This research has been accepted for presentation at the North American Primary Care Research Group’s 46th Annual Meeting in Chicago in November 2018 and is currently under review for publication.

Principal investigators: Courtenay Wilson, PharmD, associate director of pharmacotherapy, and Blake Fagan, MD, interim medical director, MAHEC Family Medicine Division; Kathy Foley, PhD, Department of Research, UNC Health Sciences at MAHEC.