Adoption of Buphenorphine in Office Practice

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DESCRIPTION (provided by applicant): In October, 2000 the Drug Addiction Treatment Act of 2000 was passed and signed into law, allowing qualified physicians to dispense or prescribe certain narcotic drugs for maintenance or detoxification treatment. According to this legislation, once buprenorphine, a maintenance medication for treatment of opiate addiction, receives FDA approval, physicians may be certified to prescribe it in office practice. Until now physicians have been prohibited from dispensing buprenorphine for opiate addiction, despite evidence of its effectiveness. This legislation is expected to improve access to treatment for thousands who are addicted to opiates by bringing into treatment both people who have rejected use of methadone and for whom methadone has failed, and physicians who wish to treat opiate dependent individuals who are appropriate for office-based treatment. Despite evidence that buprenorphine offers a needed treatment alternative, recent legislative changes and FDA approval alone may not lead to improved access for addicts. For instance, naltrexone, a pharmacological approach to alcoholism treatment, has seen limited acceptance in practice, in spite of clinical evidence of effectiveness and support of policy makers and experts. The factors contributing to the low rates of acceptance are not fully understood, but there is strong evidence that lack of financing and provider knowledge were two main barriers to naltrexone diffusion. These same factors could undermine buprenorphine diffusion into clinical practice. The proposed study seeks to understand factors related to adoption of buprenorphine in office-based practice by surveying a national sample of addiction specialists and general psychiatrists regarding their decision to prescribe buprenorphine or not, and surveying treatment settings regarding adoption and use of buprenorphine. We will examine characteristics of the clinicians, the treatment settings, and financing programs with which they are associated, in order to understand factors associated with moving research to practice, and the links between physicians and their treatment settings in deciding to adopt new treatments.