Adoption of Buphenorphine in Office Practice

描述（由申请人提供）： 2000年10月，通过了2000年《戒毒治疗法》，并签署成为法律，允许合格的医生为维持或戒毒治疗配发或开具某些麻醉药品。根据这项立法，一旦丁丙诺啡，一种用于治疗阿片类药物成瘾的维持药物，获得FDA批准，医生就可以在办公室实践中开具处方。到目前为止，尽管有证据表明丁丙诺啡有效，但医生仍被禁止为阿片类药物成瘾者配发丁丙诺啡。这项立法预计将改善数千名阿片类药物成瘾者获得治疗的机会，使拒绝使用美沙酮和美沙酮治疗失败的人以及希望治疗适合办公室治疗的阿片类药物依赖者的医生接受治疗。 尽管有证据表明丁丙诺啡提供了一种必要的治疗替代品，但最近的立法变化和FDA的批准本身可能不会改善成瘾者的获得。例如，纳洛酮是一种治疗酒精中毒的药物，尽管有临床证据证明其有效性，并得到决策者和专家的支持，但在实践中接受程度有限。导致接受率低的因素尚未完全了解，但有强有力的证据表明，缺乏资金和供应商的知识是纳洛酮扩散的两个主要障碍。这些相同的因素可能会破坏丁丙诺啡在临床实践中的扩散。 拟议的研究旨在通过调查成瘾专家和普通精神科医生的全国样本，了解与在办公室实践中采用丁丙诺啡相关的因素，这些专家和普通精神科医生决定是否处方丁丙诺啡，并调查有关采用和使用丁丙诺啡的治疗环境。我们将研究临床医生的特点，治疗环境，以及与他们相关的融资计划，以了解与将研究付诸实践相关的因素，以及医生和他们的治疗环境在决定采用新治疗方法时的联系。

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.