Overcoming Barriers to Prescribing Buprenorphine for the Treatment of Opioid Use Disorder: Recommendations from Rural Physicians
Overcoming Barriers to Prescribing Buprenorphine for the Treatment of Opioid Use Disorder: Recommendations from Rural Physicians
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DOI：
10.1111/jrh.12328
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发表时间：
2019-01-01
影响因子：
4.9
通讯作者：
Patterson, Davis G.
中科院分区：
文献类型：
--
作者：
Andrilla, C. Holly A.;Moore, Tessa E.;Patterson, Davis G.
目的美国正处于严重的阿片类药物使用障碍流行之中。丁丙诺啡是一种有效的基于办公室的治疗方法，可以由医生，护士执业者和医生助理处方，并获得缉毒局（DEA）豁免。然而，许多供应商报告的障碍，使他们要么获得DEA豁免或充分利用它。研究小组采访了农村医生成功地处方丁丙诺啡，以确定克服常见的障碍提供这项服务的策略。方法面试候选人从一份农村医生名单中随机选择，这些医生在2016年的一项调查中报告治疗了大量患者，并获得了DEA豁免，可以开丁丙诺啡。43名为大量患者开丁丙诺啡处方的农村医生接受了采访，了解他们如何克服之前在该调查中发现的处方障碍。结果受访的医生报告了许多方法来克服常见的障碍，在农村地区提供丁丙诺啡治疗。主要建议包括：（1）开始和维持药物辅助治疗，（2）尽量减少DEA的侵入和药物转移，以及（3）解决缺乏精神卫生提供者和围绕阿片类药物使用障碍（OUD）的污名问题。总的来说，医生发现提供这项服务是非常有益的。结论尽管存在已知的障碍，全国各地的农村医生已经成功地将丁丙诺啡治疗纳入他们的实践。非处方提供者可以从成功的处方者使用的策略中学习，以增加这项服务。
Purpose The United States is in the midst of a severe opioid use disorder epidemic. Buprenorphine is an effective office-based treatment that can be prescribed by physicians, nurse practitioners, and physician assistants with a Drug Enforcement Administration (DEA) waiver. However, many providers report barriers that keep them from either getting a DEA waiver or fully using it. The study team interviewed rural physicians successfully prescribing buprenorphine to identify strategies for overcoming commonly cited barriers for providing this service. Methods Interview candidates were randomly selected from a list of rurally located physicians with a DEA waiver to prescribe buprenorphine who reported treating high numbers of patients on a 2016 survey. Forty-three rural physicians, who were prescribing buprenorphine to a high number of patients, were interviewed about how they overcame prescribing barriers previously identified in that survey. Findings Interviewed physicians reported numerous ways to overcome common barriers to providing buprenorphine treatment in rural areas. Key recommendations included ways to (1) get started and maintain medication-assisted treatment, (2) minimize DEA intrusion and medication diversion, and (3) address the lack of mental health providers and stigma surrounding opioid use disorder (OUD). Overall, physicians found providing this service to be very rewarding. Conclusions Despite known barriers, rural physicians around the country have been successful in adding buprenorphine treatment to their practices. Nonprescribing providers can learn from the strategies used by successful prescribers to add this service.