Barriers and facilitators to prescribing buprenorphine for treating opioid use disorder among emergency department and other practice setting physicians

James A. Swartz; Dana Franceschini; Nora M. Marino; Adrienne H. Call; Lisa Rosenberger; Sarah Whitehouse; James A. Swartz; Dana Franceschini; Nora M. Marino; Adrienne H. Call; Lisa Rosenberger; Sarah Whitehouse

doi:10.3934/publichealth.2025005

AIMS Public Health

2025, Volume 12, Issue 1: 56-76. doi: 10.3934/publichealth.2025005

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Barriers and facilitators to prescribing buprenorphine for treating opioid use disorder among emergency department and other practice setting physicians

1.
Jane Addams College of Social Work, University of Illinois Chicago, 1040 W. Harrison St., MC (309), Chicago IL 60607, USA
2.
National Opinion Research Center at the University of Chicago, 55 East Monroe St, 30th Floor, Chicago IL 60603, USA

Received: 16 May 2024 Revised: 03 July 2024 Accepted: 23 August 2024 Published: 09 January 2025

Despite federal legislation intended to increase the prescribing of buprenorphine as medication for opioid use disorder (MOUD), such as the Drug Addiction Treatment Act (DATA) of 2000, most providers have continued to prescribe to some patients or to not prescribe at all. We aimed to determine the continuing barriers and supports needed for expanding buprenorphine prescribing and compared barriers experienced by emergency department (ED) physicians with those in other practice settings, given the unique aspects of the ED practice setting. We obtained survey data from August through November 2021 from 412 X-waivered Illinois physicians licensed to prescribe buprenorphine as MOUD, 95 (23.1%) of whom worked primarily in a hospital-based ED. Survey questions included: 1) Professional background, practice characteristics, and prescribing practices; 2) barriers to prescribing buprenorphine; 3) barriers to expanding prescribing; and 4) training/additional supports needed to facilitate buprenorphine prescribing. We used bivariate crosstabulations and multivariable OLS and binary logistic regressions to compare the responses of physicians practicing in the ED versus other practice settings and to compare physicians who prescribed buprenorphine in the past year with those who had not. There were few statistically significant differences among the examined subgroups indicating general agreement regardless of practice setting and prescribing status. The most frequently perceived barrier was having an inadequate community-based behavioral health treatment system to which OUD patients could be referred. Insurance reimbursement, difficulties building practice- and community-based systems to support buprenorphine prescribing, and challenges knowing where and how to refer patients for follow-up and ongoing support services were also prominent concerns. Based on study findings, efforts to expand buprenorphine for OUD might focus on providing support to make and manage treatment referrals and expanding the availability of community-based behavioral healthcare services. Building networks of care could potentially have a greater impact on MOUD availability than increasing the number of practitioners trained to prescribe buprenorphine.
- buprenorphine,
- medication for opioid use disorders,
- MAT,
- emergency department,
- opioid-related overdoses,
- Drug Addiction Treatment Act,
- X-waiver
Citation: James A. Swartz, Dana Franceschini, Nora M. Marino, Adrienne H. Call, Lisa Rosenberger, Sarah Whitehouse. Barriers and facilitators to prescribing buprenorphine for treating opioid use disorder among emergency department and other practice setting physicians[J]. AIMS Public Health, 2025, 12(1): 56-76. doi: 10.3934/publichealth.2025005

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Abstract

Despite federal legislation intended to increase the prescribing of buprenorphine as medication for opioid use disorder (MOUD), such as the Drug Addiction Treatment Act (DATA) of 2000, most providers have continued to prescribe to some patients or to not prescribe at all. We aimed to determine the continuing barriers and supports needed for expanding buprenorphine prescribing and compared barriers experienced by emergency department (ED) physicians with those in other practice settings, given the unique aspects of the ED practice setting. We obtained survey data from August through November 2021 from 412 X-waivered Illinois physicians licensed to prescribe buprenorphine as MOUD, 95 (23.1%) of whom worked primarily in a hospital-based ED. Survey questions included: 1) Professional background, practice characteristics, and prescribing practices; 2) barriers to prescribing buprenorphine; 3) barriers to expanding prescribing; and 4) training/additional supports needed to facilitate buprenorphine prescribing. We used bivariate crosstabulations and multivariable OLS and binary logistic regressions to compare the responses of physicians practicing in the ED versus other practice settings and to compare physicians who prescribed buprenorphine in the past year with those who had not. There were few statistically significant differences among the examined subgroups indicating general agreement regardless of practice setting and prescribing status. The most frequently perceived barrier was having an inadequate community-based behavioral health treatment system to which OUD patients could be referred. Insurance reimbursement, difficulties building practice- and community-based systems to support buprenorphine prescribing, and challenges knowing where and how to refer patients for follow-up and ongoing support services were also prominent concerns. Based on study findings, efforts to expand buprenorphine for OUD might focus on providing support to make and manage treatment referrals and expanding the availability of community-based behavioral healthcare services. Building networks of care could potentially have a greater impact on MOUD availability than increasing the number of practitioners trained to prescribe buprenorphine.

Acknowledgments

The authors would like to thank Ms. Emalee Pearson and Ms. Lauren Coxx for their able management during the early and mid-phases of the SUPPORT project. We would also like to thank Ms. Sharuti Madan for her assistance in providing background research for constructing the survey questionnaire.
Funding for the parent project on which this study is based was provided by the Illinois Department of Healthcare and Family Services through a SUPPORT grant (#43CZZ03218) from the Centers for Medicare and Medicaid Services (CMS).

Authors' contribution

James A. Swartz had full access to all study data and takes responsibility for the integrity of the data and accuracy of the data analysis. James A. Swartz, Dana Franceschini, Nora M. Marino, and Adrienne H. Call were responsible for concepts and survey design. Nora M. Marino, Adrienne H. Call, Lisa Rosenberger, and Sarah Whitehouse contributed to survey design, administration, revision, and data acquisition. James A. Swartz was primarily responsible for drafting the manuscript. All authors including James A. Swartz, Dana Franceschini, Nora M. Marino, Adrienne H. Call, Lisa Rosenberger, and Sarah Whitehouse contributed to reviewing, earlier drafts and revising the manuscript for content.

Conflict of interest

James A. Swartz is an editorial board member for AIMS Public Health and was not involved in the editorial review or the decision to publish this article. All authors declare that there are no competing interests.

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