Integrating Buprenorphine Treatment into Office-Based Practice

A Qualitative Study

The use of opioid agonists, such as buprenorphine, has been endorsed by an National Institute of Health (NIH) consensus panel as the recommended treatment for treating opioid-dependent patients. Buprenorphine reduces cravings for opioid drugs and is effective at preventing withdrawal and lowering relapse rates. However, little is known about why physicians do, or don’t, use buprenorphine maintenance treatment (BMT) in clinical practice. Since the United States has a shortage of available BMT programs, making BMT available in regular clinical care could help alleviate this shortage.

This qualitative study used individual and group semistructured interviews to elucidate barriers and facilitators to the use of BMT in clinical practice. Twenty-three physicians participated in the study; demographic data were collected on 20 of them. Five reported previous experience with buprenorphine, including having the necessary Drug Enforcement Agency registration to prescribe the drug.

After analyzing survey responses, the authors grouped answers into common themes. For example, barriers to using BMT that came up repeatedly included lack of expertise in treating addiction, competing activities that cut into time to learn about/use new treatments, lack of interest in treating addiction, and concerns about staff ability to handle BMT and staff resources to do so. Perceived advantages of using BMT in clinics included better continuity of care and higher patient satisfaction due to not having to refer patients off-site, that BMT is a good alternative to methadone, and that buprenorphine has low abuse potential. Although this study has several limitations, including small sample size and the qualitative design of the study, analyses of surveys reveals important barriers that need to be addressed in order to increase the use of BMT in clinical practice. The physicians who had experience using BMT in practice reported positive feedback from patients receiving this treatment.