Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US
Abstract Background Medications for opioid use disorder (OUD) are effective at preventing overdose and infectious disease but are vastly under-prescribed in the US. For decades, prescribers faced additional training and regulation to prescribe buprenorphine which stigmatized the medication and lesse...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | Harm Reduction Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12954-023-00918-3 |
| _version_ | 1827399587359358976 |
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| author | Berkeley Franz Lindsay Y. Dhanani O. Trent Hall Daniel L. Brook Janet E. Simon William C. Miller |
| author_facet | Berkeley Franz Lindsay Y. Dhanani O. Trent Hall Daniel L. Brook Janet E. Simon William C. Miller |
| author_sort | Berkeley Franz |
| collection | DOAJ |
| description | Abstract Background Medications for opioid use disorder (OUD) are effective at preventing overdose and infectious disease but are vastly under-prescribed in the US. For decades, prescribers faced additional training and regulation to prescribe buprenorphine which stigmatized the medication and lessened support for a harm reduction approach to treating opioid use disorder. The Drug Enforcement Administration removed the X-waiver requirement for prescribing buprenorphine in late 2022, which removed stigma and lessened important barriers to prescribing but also left training at the discretion of individual organizations. Our study aimed to assess differences in knowledge, confidence, and stigma regarding buprenorphine between those who went through the X-waiver training and those who did not, among practicing primary care providers (PCPs). Methods We assessed buprenorphine prescribing readiness among primary care aligned outpatient providers in Ohio, USA. Using survey data, we conducted bivariate and regression analyses predicting primary prescribing outcomes. Primary outcomes measured knowledge of and confidence in buprenorphine, as well as perceived adequacy of one’s training. Secondary outcomes were attitudes toward patients with OUD, including bias toward OUD patients, stress when working with them, and empathy toward them. Participants (n = 403) included physicians, nurse practitioners, and physician assistants practicing in primary care aligned disciplines. Results Survey data showed that PCPs who received X-waiver training were more likely to understand and have confidence in the mechanism of buprenorphine, and consider their training on treating OUD to be adequate. PCPs with an X-waiver showed more empathy, less negative bias, and experienced less stress when working with patients with OUD. Conclusion Removing restrictive policies for prescribing buprenorphine is an important step to expanding access and reducing the stigma associated with opioid use disorder treatment. Yet, our findings suggest that the training received alongside regulation may be important for improving prescribing confidence and reducing stigma. Strategies to increase buprenorphine prescribing are unlikely to be effective without also expanding access to prescribing support for primary care providers across the career course. |
| first_indexed | 2024-03-08T19:48:15Z |
| format | Article |
| id | doaj.art-547680c4ce064986ab8a145028f1d510 |
| institution | Directory Open Access Journal |
| issn | 1477-7517 |
| language | English |
| last_indexed | 2024-03-08T19:48:15Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj.art-547680c4ce064986ab8a145028f1d5102023-12-24T12:13:14ZengBMCHarm Reduction Journal1477-75172023-12-012011910.1186/s12954-023-00918-3Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the USBerkeley Franz0Lindsay Y. Dhanani1O. Trent Hall2Daniel L. Brook3Janet E. Simon4William C. Miller5Ohio University Heritage College of Osteopathic Medicine, Appalachian Institute to Advance Health Equity ScienceRutgers University School of Management and Labor RelationsDepartment of Psychiatry and Behavioral Health, Ohio State University Wexner Medical CenterOhio State University College of Public HealthOhio University College of Health Sciences and ProfessionsGillings School of Global Public Health, University of North Carolina Chapel HillAbstract Background Medications for opioid use disorder (OUD) are effective at preventing overdose and infectious disease but are vastly under-prescribed in the US. For decades, prescribers faced additional training and regulation to prescribe buprenorphine which stigmatized the medication and lessened support for a harm reduction approach to treating opioid use disorder. The Drug Enforcement Administration removed the X-waiver requirement for prescribing buprenorphine in late 2022, which removed stigma and lessened important barriers to prescribing but also left training at the discretion of individual organizations. Our study aimed to assess differences in knowledge, confidence, and stigma regarding buprenorphine between those who went through the X-waiver training and those who did not, among practicing primary care providers (PCPs). Methods We assessed buprenorphine prescribing readiness among primary care aligned outpatient providers in Ohio, USA. Using survey data, we conducted bivariate and regression analyses predicting primary prescribing outcomes. Primary outcomes measured knowledge of and confidence in buprenorphine, as well as perceived adequacy of one’s training. Secondary outcomes were attitudes toward patients with OUD, including bias toward OUD patients, stress when working with them, and empathy toward them. Participants (n = 403) included physicians, nurse practitioners, and physician assistants practicing in primary care aligned disciplines. Results Survey data showed that PCPs who received X-waiver training were more likely to understand and have confidence in the mechanism of buprenorphine, and consider their training on treating OUD to be adequate. PCPs with an X-waiver showed more empathy, less negative bias, and experienced less stress when working with patients with OUD. Conclusion Removing restrictive policies for prescribing buprenorphine is an important step to expanding access and reducing the stigma associated with opioid use disorder treatment. Yet, our findings suggest that the training received alongside regulation may be important for improving prescribing confidence and reducing stigma. Strategies to increase buprenorphine prescribing are unlikely to be effective without also expanding access to prescribing support for primary care providers across the career course.https://doi.org/10.1186/s12954-023-00918-3Opioid-related disordersPrimary careMisinformationBuprenorphineAddiction medicineMedications for opioid use disorder |
| spellingShingle | Berkeley Franz Lindsay Y. Dhanani O. Trent Hall Daniel L. Brook Janet E. Simon William C. Miller Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US Harm Reduction Journal Opioid-related disorders Primary care Misinformation Buprenorphine Addiction medicine Medications for opioid use disorder |
| title | Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US |
| title_full | Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US |
| title_fullStr | Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US |
| title_full_unstemmed | Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US |
| title_short | Differences in buprenorphine prescribing readiness among primary care professionals with and without X-waiver training in the US |
| title_sort | differences in buprenorphine prescribing readiness among primary care professionals with and without x waiver training in the us |
| topic | Opioid-related disorders Primary care Misinformation Buprenorphine Addiction medicine Medications for opioid use disorder |
| url | https://doi.org/10.1186/s12954-023-00918-3 |
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