Assessing waivered and non-waivered physician barriers to treating patients with substance use disorders: a cross-sectional Kentucky pilot

Abstract

Introduction

Opioid and other substance use disorders (OUD/SUDs) have been and continue to be significant public health issues. The standard of care for OUD is the use of medication for opioid use disorder (MOUD) in conjunction with counseling or behavioral therapies, yet research has indicated that barriers exist for patients accessing MOUD as well as for physicians prescribing MOUD due to requirements associated with the DATA 2000 waiver.

Methods

A pilot cross-sectional survey was conducted among Kentucky physicians in order to reassess common barriers as well as to explore barriers that non-waivered providers face to becoming waivered. Barriers were compared by waiver status (waiver vs. non-waivered) as well as geographic location (rural vs. non-rural).

Results

Compared to waivered physicians, non-waivered physicians were significantly less likely to report positive personal beliefs related to the use of MOUD for OUD and reported significantly more barriers to treating OUD patients in the areas of physicians’ practice and culture, auditing, and institutional support and resources (p < .05). The majority (69%) of all physicians indicated they would benefit from a tool kit with evidence-based clinical guidelines.

Conclusions

The barriers and beliefs identified in this pilot study indicate the need for policy action at the federal level to reduce barriers and incentivize more physicians to obtain waivers to treat OUD. Further, the development of brief educational resources tailored to physicians to treat OUD patients including pregnant patients with OUD is recommended.

Keywords:

• Substance-related disorders
• buprenorphine
• opioid-related disorders
• physicians
• primary care
• rural health

Acknowledgements

The authors would like to thank Grace Clancy, Fletcher Group; and B. Levi Bolin. Ph.D., Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities for their help developing the survey questions. We would also like to thank the physicians at Fresh Start Health Centers in Kentucky for their feedback in refining survey questions. We would also like to thank the Kentucky Academy of Family Physicians and the Kentucky Primary Care Association for helping to disseminate the survey as well as all physicians that participated.

Disclosure statement

The authors have no potential conflicts of interests or financial disclosures.

Additional information

Funding

This project was supported by the Kentucky Opioid Response Effort (KORE) through a Substance Abuse and Mental Health Services Administration (SAMHSA) Grant 1H79TI081704. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Substance Abuse and Mental Health Services Administration (SAMHSA).