Buprenorphine Medication-assisted Treatment Research Articles

Trends, patterns, and maternal characteristics of opioid prescribing during pregnancy in a large population-based cohort study

BackgroundOpioid use during pregnancy has been associated with adverse maternal and infant health outcomes. Prescription drug monitoring programs (PDMP) provide a population-based source of prescription data. We linked statewide PDMP and birth certificate data in Tennessee (TN) to determine patterns of prescription opioid and benzodiazepine use during pregnancy. MethodsWe constructed a cohort of 311,217 live singleton births from 2013 to 2016 with prescription history from 90 days before pregnancy to birth. Descriptive statistics were used to describe opioid prescription patterns during pregnancy overall, by maternal characteristics and by year. Multivariable logistic regression models estimated adjusted odds ratios and 95% confidence intervals for factors associated with prescription use. ResultsThe prevalence of prescription use during pregnancy was 14.1% for opioid analgesics, 1.6% buprenorphine for medication-assisted treatment, and 2.6% for benzodiazepines. The prevalence of opioid analgesic use decreased from 16.6% (2013) to 11.8% (2016) (ptrend< 0.001). About 25% used for > 7 and 9.7% for > 30 days’ supply. The most common types were hydrocodone (9.3%), codeine (3.4%), and oxycodone (2.9%). In adjusted models, lower education, lower income, pre-pregnancy obesity and smoking during pregnancy were associated with increased odds of any opioid and opioid analgesic use. Conclusion(s)Despite the encouraging trend of decreasing use of prescription opioid analgesics, the overall prevalence remained close to 12% with many women using for long durations. Use was associated with lower socioeconomic status, obesity, and prenatal smoking. Findings highlight the need for maternal education and resources, and provider support for implementation of evidence-based care.

Buprenorphine Dosage and Urine Quantitative Buprenorphine, Norbuprenorphine, and Creatinine Levels in an Office-Based Opioid Treatment Program.

Background:Treatment progress is routinely monitored by urine testing in patients with opioid use disorder (OUD) undergoing buprenorphine medication-assisted treatment (MAT). However, interpretation of urine test results could be challenging. This retrospective study aims to examine the results of quantitative buprenorphine, norbuprenorphine, and creatinine levels in urine testing in relation to sublingual buprenorphine dosage to facilitate an accurate interpretation of urine testing results.Methods:We reviewed the medical charts of 41 consecutive patients, who were residing in halfway houses where their medication intake was closely monitored and who had enrolled in an office-based MAT program at an urban clinic between July 2018 and June 2019. The patients’ urine testing results were reviewed, and demographic variables were recorded. We focused on the patients treated with 8-, 12-, or 16-mg/day of buprenorphine, examining their urine buprenorphine, norbuprenorphine, and creatinine levels. Analysis of variance tested the statistical association between the dosage and urine testing results on the norbuprenorphine-to-creatinine ratio.Results:A total of 240 urine samples from 41 patients were included for this study. The 41 patients received a mean buprenorphine dose of 10.5 ± 3.7 mg/day (range, 4-20 mg/day). Then, this study examined the distribution of the 240 urine samples and then focused on 184 urine samples that came from the 33 patients who were treated with 8-, 12-, and 16-mg/day of buprenorphine, the 3 most common dosages. All of the 184 urine samples had a creatinine level of >20 mg/dL and buprenorphine-to-norbuprenorphine ratio <50:1. The average norbuprenorphine-to-creatinine ratio in the 8 mg/day dosage group was 3.85 ± 2.24 × 10−4 (n = 66; range, 0.44-11.12). The respective ratios in the 12- and 16-mg dosage groups were 5.64 ± 3.40 × 10−4 (n = 83; range, 1.55-22.72) and 6.23 ± 4.92 × 10−4 (n = 35; range, 1.37-27.12). The 3 dosage groups differed significantly in the mean ratios (P < .01), except when the 12- and 16-mg dosage groups were compared (P = .58). The results of this study thus suggest that prescribers should pay attention to the following features: (1) unexpected substance(s) in urine testing, (2) creatinine level under 20 mg/dL, (3) buprenorphine-to-creatinine ratio over 50:1, (4) buprenorphine dosage over 24 mg/day, and (5) norbuprenorphine-to-creatinine ratio consistently under 0.5 × 10−4 in patients treated with 8 mg/day or 1.5 × 10−4 in patients treated with 12 mg/day or more.Conclusion:This study suggested parameters for interpreting quantitative urine test results in relation to buprenorphine intake dose in office-based opioid treatment programs.

Real-world reduction in healthcare resource utilization following treatment of opioid use disorder with reSET-O, a novel prescription digital therapeutic

ABSTRACT Introduction Buprenorphine medication assisted treatment (B-MAT) adherence for opioid use disorder (OUD) is suboptimal. reSET-O, an FDA-cleared prescription digital therapeutic, delivers neurobehavioral therapy (community-reinforcement approach+fluency training+contingency management) to B-MAT-treated OUD patients. Methods This retrospective claims study (10/01/2018-10/31/2019) evaluated healthcare resource utilization up to 6 months before/after reSET-O initiation. Repeated-measures negative binomial models compared incidences of encounters/procedures. Net change in costs was assessed. Results Among 351 patients (mean age 37; 59.5% female; 82.6% Medicaid), 334 had pharmacy claims and 240 (71.9%) received buprenorphine pre-/post-index (medication possession ratio 0.73 and 0.82, respectively; P = 0.004). Facility encounters decreased, with 45 fewer inpatient (P = 0.024) and 27 fewer emergency department (ED) visits (P = 0.247). Clinical encounters with largest changes were drug testing (638 fewer; P < 0.001), psychiatry (349 fewer; P = 0.036), case management (176 additional; P = 0.588), other pathology/laboratory (166 fewer; P = 0.039), office/other outpatient (154 fewer; P = 0.302), behavioral rehabilitation (111 additional; P = 0.124), alcohol/substance rehabilitation (96 fewer; P = 0.348), other rehabilitation (66 fewer; P = 0.387), mental health rehabilitation (61 additional; P = 0.097), and surgery (60 fewer; P = 0.070). Changes in facility/clinical encounters saved $2,150/patient. Conclusion reSET-O initiation was associated with fewer inpatient, ED, and other clinical encounters, increased case management/rehabilitative services, and lower net costs over six months. Expert Opinion Real-world evidence is helpful in evaluating the effectiveness of interventions in usual-care conditions, outside of controlled research environments. Large observational studies based on health care claims are important to understand the actual pharmacoeconomic and outcomes impact of interventions at the health care system and population level.

Medical utilization surrounding initial opioid-related diagnoses by coding method.

To identify methods for coding initial opioid-related disorder (ORD) diagnoses in administrative claims and determine whether coding methods correspond to acute medical utilization patterns. Retrospective analysis of Blue Health Intelligence commercial data. We included members with 2 years of continuous coverage around the first appearance of an ORD diagnosis code (initial ORD) in medical or pharmacy claims with dates of service between October 2015 and March 2016. Initial ORD was identified by International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) F11 codes or buprenorphine for medication-assisted treatment (BUP-MAT) with a duration of 3 or more days. Descriptive analyses were evaluated prediagnosis, in the month of diagnosis, and post diagnosis and included mean cost per member per month (PMPM); mean monthly percentage of members with at least 1 opioid agonist prescription (OAP), inpatient visit, or emergency department (ED) visit; and percentage of members with at least 1 ICD-10-CM Z79.891 code (long-term [current] use of opiate analgesic). A total of 6426 initial ORD diagnoses were identified by F11.20 (65.2%), F11.x (28.7%), and BUP-MAT (6.1%). PMPM costs for BUP-MAT ($2054) were lower than for F11.20 ($5053) and F11.x ($6597) in the diagnosis month. Mean monthly percentage of members with at least 1 OAP declined from pre- to post initial ORD diagnosis (F11.20, 52.5% to 50.0%; F11.x, 44.1% to 37.9%; BUP-MAT, 34.0% to 12.7%). Members with initial ORD coded as F11.x had the highest mean percentage with at least 1 inpatient or ED visit in the diagnosis month (30.9% and 26.8%, respectively) versus F11.20 (19.3% and 10.8%) and BUP-MAT (5.1% and 3.5%). Percentage of members with at least 1 Z79.891 code was higher post diagnosis than in the month of diagnosis (F11.20, 34.6% vs 25.7%; F11.x, 16.5% vs 8.1%; BUP-MAT, 19.5% vs 8.1%). Medical utilization patterns of members with ORD differ by the coding method used to document their initial diagnosis in administrative claims.

Drug screening during pregnancy: Urine dip cups measure up

BackgroundSubstance use during pregnancy is a major medical and public health concern. Determination of the most appropriate screening protocol remains a clinical conundrum. Interviews and/or laboratory drug screens may be costly, inaccurate, and are frequently inadequate to identify patterns of substance use for a given population or geographic area. We compared commercially available urine “dip cup” toxicology screens obtained in the clinic to university hospital drug toxicology results. Methods267 observed urine samples were collected from pregnant women with known substance use disorders enrolled in a specialized treatment program that included access to buprenorphine medication-assisted treatment. Each urine sample was tested by commercial dip cup with temperature confirmation and then sent to the university hospital laboratory for analyses. The number of substances detected and cost for each screening method were compared. ResultsUniformly, the dip cup had comparable detection of amphetamines, barbiturates, cocaine, methadone, opiates, and tetrahydrocannabinol to the university hospital laboratory with the exception of benzodiazepines. In addition, the dip cup detected use of buprenorphine (a commonly misused opiate receptor ligand not included in the hospital screen) and was significantly less expensive. ConclusionsCommercially available urine dip cups are cost-effective, equally comparable to hospital based screening, and provide ‘real time’ results germane to clinical care and treatment planning.

Use of naltrexone in treating opioid use disorder in pregnancy

The mainstay of the management of opioid use disorder in pregnancy is with methadone or buprenorphine medication-assisted treatment. Methadone and buprenorphine are opioid agonist drugs. Naltrexone, an opioid antagonist, is also a medication-assisted treatment option; however, to date, only a few retrospective studies have reported its use in pregnancy. Our study objective was to evaluate prospectively obstetric and newborn outcomes and the maternal/fetal effects of the use of naltrexone as a medication-assisted treatment in pregnant patients with opioid use disorder. We performed a prospective cohort study collecting data on all pregnant women who were treated with naltrexone medication-assisted treatment compared with pregnant women who were treated with methadone or buprenorphine medication-assisted treatment. Based on a sample size calculation, it was determined that for a power of 90, a minimum of 160 study participants (80 in each group) was needed with an alpha of .01 and an expected 60% rate of newborn infants who were treated for neonatal abstinence syndrome in the methadone or buprenorphine medication-assisted treatment group compared with a 30% rate in the naltrexone medication-assisted treatment group. In a random subset of 20 maternal/newborn dyads, blood levels for naltrexone and 6-beta-naltrexol (an active metabolite) were analyzed at delivery. A total of 230 patients were studied: 121 patients with naltrexone medication-assisted treatment compared with 109 patients with methadone or buprenorphine medication-assisted treatment. No differences between groups were seen regarding demographics, the use of comedications/drugs, or obstetric outcomes. For newborn outcomes, the rate of neonatal abstinence syndrome in neonates >34 weeks gestation was significantly lower in the naltrexone medication-assisted treatment group (10/119 [8.4%] vs 79/105 [75.2%]; P<.0001). Multivariate analysis demonstrated that the only significant factor for the rate of neonatal abstinence syndrome was the form of medication-assisted treatment. Of 87 patients who received naltrexone up to delivery, no neonates experienced symptoms of neonatal abstinence syndrome. No maternal relapses occurred in the 7-day no-treatment window before the initiation of naltrexone therapy. No cases of spontaneous abortion or stillbirth occurred in either group. In 64 patients who started naltrexone therapy at ≥24 weeks gestation, no changes were seen in the fetal heart monitor tracing with drug initiation. The incidence of birth anomalies was no different between the groups. Umbilical cord blood and maternal levels for naltrexone and 6-beta-naltrexol matched; no levels were elevated, and values were undetected if naltrexone was discontinued >60 hours before delivery. These study data demonstrate that, in pregnant women who choose to completely detoxify off opioid drugs during gestation, naltrexone, as a continued form of medication-assisted treatment, is a viable option for some pregnant patients who experience opioid use disorder. Naltrexone crosses the placenta, and maternal and fetal levels are concordant. Because naltrexone clears quickly from the maternal circulation, this rapid clearance needs to be addressed with patients. This is important because maternal relapse could occur in a short time-period if the oral drug is discontinued without the knowledge of their healthcare providers. Nonetheless, the drug is well-tolerated by both mother and fetus, and newborn infants do not experience symptoms of neonatal abstinence syndrome if naltrexone medication-assisted treatment is maintained to delivery.

In With the New: Managing Acute Malignant Pain in Patients on Opioid Replacement Therapy with Buprenorphine (SA521)

•Compare and contrast the pharmacology of pure and partial opioid agonists.•Describe an approach to treating acute pain in hospice patients receiving buprenorphine and naloxone therapy.•Establish the role of buprenorphine in hospice and palliative care clinical practice. After Dole and Nyswander introduced the role of methadone in drug rehabilitation in 1965, methadone became the standard for medication assisted therapy of opioid use disorders. Similarly, hospice and palliative care professionals have recognized the role of methadone in treating cancer-related pain. Since its release in the early 2000s, buprenorphine has become the preferred medication assisted treatment option given its ability to be prescribed in a less restrictive setting, the relative ease of dosing, and reduction in stigma. Given the popularity of buprenorphine for medication assisted treatment, hospice and palliative care practitioners must be prepared to manage patients on buprenorphine who require pain management for serious illness. We will present the case of a young hospice patient with terminal cancer whose pain was being managed with combination buprenorphine and naloxone therapy for opioid use disorder. We will describe the pharmacology of buprenorphine, how it is used in medication assisted treatment and how to transition patients on buprenorphine to a more traditional opioid agonist for acute pain management. Finally, we will discuss the possible role of buprenorphine for management of pain in the setting of an opioid use disorder.

Buprenorphine medication-assisted treatment during pregnancy: An exploratory factor analysis associated with adherence

Background: The treatment of pregnant women with opioid use disorder is challenging due to the myriad of physical, mental, and social complications. Factors influencing adherence to buprenorphine during pregnancy have not been identified. Materials and methods: Pregnant women with opioid use disorder followed in a tertiary clinic were included in a retrospective chart review from buprenorphine induction through delivery. All women who had been evaluated and treated with buprenorphine from January 1, 2014, to September 31, 2016, were included. Adherence was defined as follows: 1) adherent: attended follow up visits, negative urine toxicology screens, and phase advancement; 2) moderately adherent: attended follow up visits until delivery, had not completed six negative urine toxicology screens, or had positive urine toxicology screens (i.e., no phase advancement); 3) non-adherent: missed follow up visits and did not stay in treatment until delivery. Sociodemographic characteristics, family psychiatric history, current and lifetime psychiatric and childhood trauma along with treatment factors were compared by category of adherence. Results: 64 women met criteria for inclusion in this study with 41 (64%) adherent; eight (13%) moderately adherent; and 15 (23%) non-adherent. In the non-adherent group compared to the adherent group, the clinician-rated opioid withdrawal scale score was significantly higher, and the daily buprenorphine dose at last visit was significantly lower. Conclusions: Women who were non-adherent to buprenorphine during pregnancy had higher severity of opioid withdrawal symptoms and lower doses of buprenorphine. These findings should be further explored with the goal of optimizing care without increasing risk for neonates.

Relationship between buprenorphine adherence and relapse, health care utilization and costs in privately and publicly insured patients with opioid use disorder.

BackgroundTreatment for opioid use disorder is important because of the negative health, societal and economic consequences of illicit opioid use, but treatment adherence can be a challenge. This study assessed the association between buprenorphine medication-assisted treatment (MAT) adherence and relapse, health care utilization and costs.Patients and methodsPatients with opioid use disorder who were newly initiating a buprenorphine MAT regimen were identified in the 2008–2014 MarketScan® Commercial and Medicaid Databases and followed for 12 months after their earliest outpatient pharmacy claim for buprenorphine. Adherence was categorized using proportion of days covered (PDC) with buprenorphine, and patients with PDC≥0.80 were classified as adherent. Descriptive and adjusted analyses compared relapse prevalence, utilization and costs, all measured in the 12 months following buprenorphine MAT initiation, of adherent patients to patients in non-adherent PDC categories (PDC<0.20, 0.20≤PDC<0.40, 0.40≤PDC<0.60, 0.60≤PDC<0.80).ResultsAdherent patients were 37.1% of the Commercial sample (N=16,085) and 41.3% of the Medicaid sample (N=5,688). In both samples, non-adherent patients were significantly more likely than adherent patients to relapse and to have hospitalizations and emergency department visits. As a result, as buprenorphine MAT adherence increased, pharmacy costs increased, but medical costs decreased. Total costs (pharmacy plus medical costs) in the 12 months following buprenorphine MAT initiation decreased with adherence in Commercial patients ($28,525 for PDC<0.20 to $17,844 for PDC≥0.80). A slight decrease in total costs in the 12 months following buprenorphine MAT initiation was also observed in Medicaid patients ($21,292 for PDC<0.20 to $18,621 for PDC≥0.80). After adjustment, total costs of adherent patients in the Commercial sample ($17,519) were significantly lower compared with those of non-adherent patients (range $20,294–$24,431). In the Medicaid sample, adjusted total costs were not significantly different between adherence groups.ConclusionBuprenorphine MAT adherence in the 12 months following treatment was associated with reduced odds of relapse and reduced unadjusted medical costs. For Commercial patients who were adherent to treatment, the adjusted total costs were predicted to be 30% lower than those for patients with PDC<0.20.

729: Buprenorphine for medication assisted treatment (MAT) of opioid use disorders in pregnancy: relationship to neonatal opioid withdrawal syndrome (NOWS)

729: Buprenorphine for medication assisted treatment (MAT) of opioid use disorders in pregnancy: relationship to neonatal opioid withdrawal syndrome (NOWS)

Treating prescription opioid dependence.

With the continued increase of opioid analgesic use in the United States,1 there is a parallel increase in opioid use disorder specifically involvingprescription opioids (POs).2 Thepercentageof admissions into substance abuse treatment facilities for pharmaceutical opioid dependencetreatmenthas increasedfromless than1.0%duringand before1997to9.8%in2011.3Bycontrast,admissions forherointreatment have fluctuated between 14% and 15.5% for the past 15 years. Increases in drug-related crime and spread of infectious disease are 2 societal consequences of increased opioid use disorder. Treatment usually begins by reducing or eliminating uncontrolled use of the abused opioid agonists. Widespreadmethadone maintenance treatment availabilityprovides analternative toacute withdrawal followed by self-monitored abstinence facilitating reduced relapse to the abused opioid. Strengths and weaknesses of methadone maintenance have been studied and well documented. More recently, buprenorphine replacement therapy has capitalizedonmanyof the strengthsof themethadonemodelwhile reducing barriers to treatment with its availability in mainstream medical care settings.Withbothmethadoneandbuprenorphine as tools, agonistmaintenance therapy reduces opioid use in patients. However, significant barriers to accessing agonist maintenance therapy remain.4 The study by Sigmon et al5 published in JAMA Psychiatry highlights a different treatment model in the general class of treatments known as buprenorphine medication-assisted treatment (BMAT). Althoughmost patientswith opioid usedisorder receiving agonist therapy continue to receive maintenance therapy for 6 months ormore, Sigmon et al demonstrated short-term treatment JAMAPSYCHIATRY

P.3.009 Stabilization of remission from opioid dependence with long-acting naltrexone implant

The mainstay of the management of opioid use disorder in pregnancy is with methadone or buprenorphine medication-assisted treatment. Methadone and buprenorphine are opioid agonist drugs. Naltrexone, an opioid antagonist, is also a medication-assisted treatment option; however, to date, only a few retrospective studies have reported its use in pregnancy.Our study objective was to evaluate prospectively obstetric and newborn outcomes and the maternal/fetal effects of the use of naltrexone as a medication-assisted treatment in pregnant patients with opioid use disorder.We performed a prospective cohort study collecting data on all pregnant women who were treated with naltrexone medication-assisted treatment compared with pregnant women who were treated with methadone or buprenorphine medication-assisted treatment. Based on a sample size calculation, it was determined that for a power of 90, a minimum of 160 study participants (80 in each group) was needed with an alpha of .01 and an expected 60% rate of newborn infants who were treated for neonatal abstinence syndrome in the methadone or buprenorphine medication-assisted treatment group compared with a 30% rate in the naltrexone medication-assisted treatment group. In a random subset of 20 maternal/newborn dyads, blood levels for naltrexone and 6-beta-naltrexol (an active metabolite) were analyzed at delivery.A total of 230 patients were studied: 121 patients with naltrexone medication-assisted treatment compared with 109 patients with methadone or buprenorphine medication-assisted treatment. No differences between groups were seen regarding demographics, the use of comedications/drugs, or obstetric outcomes. For newborn outcomes, the rate of neonatal abstinence syndrome in neonates >34 weeks gestation was significantly lower in the naltrexone medication-assisted treatment group (10/119 [8.4%] vs 79/105 [75.2%]; P<.0001). Multivariate analysis demonstrated that the only significant factor for the rate of neonatal abstinence syndrome was the form of medication-assisted treatment. Of 87 patients who received naltrexone up to delivery, no neonates experienced symptoms of neonatal abstinence syndrome. No maternal relapses occurred in the 7-day no-treatment window before the initiation of naltrexone therapy. No cases of spontaneous abortion or stillbirth occurred in either group. In 64 patients who started naltrexone therapy at ≥24 weeks gestation, no changes were seen in the fetal heart monitor tracing with drug initiation. The incidence of birth anomalies was no different between the groups. Umbilical cord blood and maternal levels for naltrexone and 6-beta-naltrexol matched; no levels were elevated, and values were undetected if naltrexone was discontinued >60 hours before delivery.These study data demonstrate that, in pregnant women who choose to completely detoxify off opioid drugs during gestation, naltrexone, as a continued form of medication-assisted treatment, is a viable option for some pregnant patients who experience opioid use disorder. Naltrexone crosses the placenta, and maternal and fetal levels are concordant. Because naltrexone clears quickly from the maternal circulation, this rapid clearance needs to be addressed with patients. This is important because maternal relapse could occur in a short time-period if the oral drug is discontinued without the knowledge of their healthcare providers. Nonetheless, the drug is well-tolerated by both mother and fetus, and newborn infants do not experience symptoms of neonatal abstinence syndrome if naltrexone medication-assisted treatment is maintained to delivery.

PMH58 NEW DISEASE MANAGEMENT PROGRAM FOR OPIOID DEPENDENT PATIENTS DECREASES DRUG USE AND INCREASES 12 STEP MEETING ATTENDANCE: ONE YEAR RESULTS OF A RANDOMIZED CLINICAL TRIAL

Buprenorphine-medication assisted treatment (B-MAT) is clinically effective for opioid dependence (OD). Ancillary treatment services, however, may be needed to maximize treatment efficacy. The purpose of the present study was to investigate the one year effect of a disease management program on treatment outcomes among a national sample of OD patients. Opioid dependent patients new to B-MAT (N=1.426) were randomized to receive either B-MAT plus a patient support program (intervention group, n = 987) or B-MAT alone (standard care group, n = 439). The intervention was a confidential, outbound, telephonic support program designed to provide new B-MAT patients encouragement and help them resolve problems inherent to early B-MAT treatment. Once enrolled in the study, all patients completed the Addiction Severity Index (ASI) and Treatment Services Review (TSR) at various time points over one year. The ASI is a semi structured interview designed to measure problem severity in seven functional areas known to be affected by alcohol and drug dependence. The TSR assess utilization of a variety of health, social, legal, employment, and family support services. Logistic regression analyses controlling for baseline problem severity and demographics revealed that intervention group subjects were significantly less likely to abuse opioids at month 12 (p < .05; exp (β) = 1.50), and were significantly more likely to attend 12 step/self-help group meetings for substance abuse (p < .05; exp (β) = 0.71) compared to the standard care group. Randomization to the disease management program resulted in a decrease in the reported use of opioids and an increase in self-help group counseling attendance. Supplementing B-MAT with a structured disease management program seems to be an effective way to improve patient outcomes. Current results replicate, and extend to B-MAT, findings from other studies of the effect of telephonic intervention programs on patient outcomes.

Psychiatrist Characteristics That Influence Use of Buprenorphine Medication-Assisted Treatment

: Since 2003, a new form of treatment for opioid dependence (OD), called buprenorphine medication-assisted treatment (B-MAT), has become increasingly available in the United States. The purpose of this study was to measure self-reported psychiatrists' practice patterns, personal and professional characteristics, and psychiatrists' barriers to treating OD patients with office-based opioid therapy. : Managed care network psychiatrists waivered to prescribe buprenorphine for treating OD were surveyed (N = 294) about specific skills and barriers to increasing the number of OD patients treated with B-MAT. Psychiatrists completed a self-administered survey about attitudes, beliefs, skills, experiences in general practice, and experience treating chronic disease, addiction, and OD. : Of the 11 barriers measured on the survey, the 5 that were endorsed by the greatest number of psychiatrists as affecting their decision to use B-MAT or increase the number of B-MAT patients were as follows: urine testing requirements and logistical issues, possibility of patients selling their buprenorphine or taking more than prescribed, attracting more OD patients to their practice, concern about drug enforcement agency intrusion, and belief of greater time commitment for treating B-MAT patients. : Barriers were perceived to exist, and the perception of the level of these barriers varied significantly between psychiatrists whose B-MAT practices were growing and those whose practices were not. The findings suggest that to increase the use of B-MAT by waivered psychiatrists, support services and medical education programs should focus on the barriers that are rated the most influential by psychiatrists whose patient sample was decreasing or remaining flat.

A national study of a telephone support service for patients receiving office-based buprenorphine medication-assisted treatment: Study feasibility and sample description

Opioid-dependent (OD) patients seeking treatment have multiple treatment options including abstinence-based and medication replacement therapies. A recent and growing addition to medication replacement therapy is buprenorphine medication-assisted treatment (B-MAT), which may be provided by certified physicians practicing in private offices. Research on OD treatment is often performed on samples of patients recruited from specialty treatment facilities, which may not generalize to B-MAT patients. Thus, B-MAT as a treatment approach has been understudied. The present research describes (a) new methods developed to facilitate sample recruitment and survey data collection from a national B-MAT patient sample and (b) a telephonic support program designed for new B-MAT patients. Results indicate that by using appropriate tools, it is feasible to conduct a clinical study of B-MAT patients, recruited at the point of service, and that telephonic patient support was an acceptable treatment adjunct.