Adoption of Buphenorphine in Office Practice

描述(由申请人提供)： 2000年10月，通过并签署了2000年《药物成瘾治疗法》，允许有资格的医生为维持或戒毒治疗配发或开出某些麻醉药品。根据这项立法，丁丙诺啡是一种治疗阿片成瘾的维持药物，一旦获得FDA批准，医生可能会被认证在办公室开具处方。到目前为止，医生一直被禁止分发丁丙诺啡治疗阿片成瘾，尽管有证据表明它是有效的。这项立法预计将通过将拒绝使用美沙酮和美沙酮失败的人，以及希望治疗适合办公室治疗的鸦片依赖者的医生纳入治疗，从而改善数千名鸦片成瘾者获得治疗的机会。 尽管有证据表明丁丙诺啡提供了一种必要的治疗替代方案，但最近的立法变化和FDA的批准可能不会改善吸毒者的获得途径。例如，纳曲酮是一种治疗酒精中毒的药理学方法，尽管有临床证据表明有效，并得到了政策制定者和专家的支持，但在实践中被接受的程度有限。造成纳曲酮接受率低的因素尚不完全清楚，但有强有力的证据表明，缺乏资金和供应商知识是纳曲酮推广的两个主要障碍。这些同样的因素可能会破坏丁丙诺啡在临床上的扩散。 这项拟议的研究试图通过调查全国成瘾专家和普通精神病学家的样本，了解他们是否决定开丁丙诺啡，并调查有关采用和使用丁丙诺啡的治疗环境，以了解在办公室实践中采用丁丙诺啡的相关因素。我们将检查临床医生的特点、治疗设置和与他们相关的融资计划，以了解将研究转化为实践的相关因素，以及医生和他们的治疗设置之间的联系，以决定采用新的治疗方法。

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.