Limited access to buprenorphine restricts resident physicians treating opioid abusers

A survey of resident physicians in Florida indicates they are interested in treating opioid addiction but face barriers to offering patients treatment using buprenorphine, an FDA-approved medication shown to successfully decrease opioid use, overdose events, and deaths associated with opioids.

Resident physicians often care for patients with opioid addiction, described in medical terms as Opioid Use Disorder (OUD), but do not have the skill set or knowledge to treat OUD.

These are the findings from a study, led by University of South Florida Health (USF Health) physician researchers, that were recently published in the Journal of Addiction Medicine. The study is one of the first to evaluate what barriers resident physicians face in prescribing buprenorphine for opioid addiction and their attitudes towards treating opioid addiction.

Currently, health care providers must complete training in order to obtain a waiver to prescribe buprenorphine, but only 5% of all practicing physicians have this waiver.

The USF Health researchers surveyed resident physicians across all 35 Internal Medicine residency training programs in Florida that are accredited by the Accreditation Council for Graduate Medical Education (ACGME). They found that 42% of respondents planned to obtain a buprenorphine waiver and that only 3% of these residents were currently waivered.

"The opioid epidemic continues to claim over 45,000 deaths per year -unfortunately, only 20% of patients with opioid addiction receive medical treatment. Medications like buprenorphine can radically improve the lives of people who have opioid addiction, but these medications are underutilized by providers," said the study's lead author Bryant Shuey, MD, a third-year resident for the Department of Internal Medicine in the USF Health Morsani College of Medicine in Tampa, Fla.

"Providers must complete a training in order to obtain a waiver to prescribe buprenorphine. But only 5% of practicing physicians have this waiver, leaving few prescribers prepared to address the opioid epidemic. Resident physicians are the front line of our health care workforce and are poised to be leaders in treating opioid addiction. Yet, few studies have evaluated what residents know about opioid addiction and what barriers they face when trying to manage opioid addiction. This study is one of the first to evaluate what barriers resident physicians face in prescribing buprenorphine for opioid addiction and their attitudes towards treating opioid addiction."

The survey also found that:

• 73% of residents cared for patients with opioid addiction more than once per month.
• Three-quarters of residents reported that their programs do not provide training in treatment of OUD using buprenorphine.
• Residents scored poorly on survey knowledge questions about treating opioid addiction.
• Residents described limited knowledge about diagnosis and management of opioid addiction as the most important barrier to prescribing buprenorphine followed by a lack of awareness of the medication.
• Residents interested in general medicine and those who cared for patients more frequently with opioid addiction were more likely to be interested in obtaining a buprenorphine waiver.

"Residents in our study overwhelmingly support deregulating buprenorphine for the treatment of OUD," Shuey said, referencing calls by national addiction experts to remove the waiver requirement to prescribe buprenorphine altogether. "Ultimately, residents are interested in expanding their role in treating opioid addiction but face significant limitations in knowledge, experience, and skills."

More than 40 states have reported increased deaths from opioids since the COVID-19 pandemic began, underscoring the need to remove barriers to treatment, according to the American Medical Association.