Buprenorphine Maintenance Treatment of Opiate Dependence: Correlations Between Prescriber Beliefs and Practices

ABSTRACT

Background: Despite the existence of evidence-based guidelines, different prescriber practices around buprenorphine maintenance treatment (BMT) of opiate dependence exist. Moreover, certain prescriber beliefs may influence their practice patterns. Objective: To understand community BMT practice patterns and discern their relationship to practitioner beliefs. Method: Survey of 30 local BMT prescribers about aspects of BMT, and analysis of correlations between practices and practitioner beliefs. Results: Practitioners generally followed standard treatment guidelines, though the most-common maintenances dosages of BMT (4–12 mg) were lower than recommended by some studies. Endorsement of belief in a “spiritual basis” of addiction correlated with lower average BMT doses and less frequent endorsement of the belief that BMT-treated patients are “in recovery.” Conclusions/Importance: These data suggest that relatively standardized, longer-term BMT of opiate dependence is accepted among the majority of surveyed prescribers, and certain provider beliefs about addiction may influence prescribing habits and attitudes. Future studies should: (1) assess these findings in larger samples; (2) examine how prescriber beliefs about addiction and BMT compare with those of other addiction treatment providers; and (3) ascertain whether individual prescriber beliefs influence patient outcomes.

Keywords:

• Opiate dependence
• buprenorphine
• psychopharmacology
• stigma

Glossary

• BMT: Buprenorphine maintenance therapy

• OD: Opiate dependence

• Prescriber beliefs: In this article, denotes endorsement of global statements about aspects of substance use disorders or their treatment (i.e., “addiction has a spiritual basis”)

Acknowledgments

Gratitude is extended to the volunteers who completed the survey. Acknowledgments to Matio Scott MacDonald, who assisted with data collection and entry.

Declaration of interest

Wendy Khentigan, MD, is a Treatment Advocate for Reckitt Benckiser. All other authors report no conflicts of interests. The authors alone are responsible for the content and writing of this article.

Funding

Kai MacDonald's research is partly supported by the Goodenough Neuroscience Research Fund.

Additional information

Notes on contributors

Kai MacDonald

Kai MacDonald, MD, is an Assistant Clinical Professor in the Departments of Psychiatry and Family Medicine and Public Health at the UCSD School of Medicine, a Fellow of the American Psychiatric Association, and Medical Director of Lasting Recovery Substance Abuse Treatment Program. As the primary researcher and coordinator of this project, he designed the study, gathered the data, and wrote the first draft of the manuscript. Dr. MacDonald has published peer-reviewed articles on a variety of subjects, including the therapeutic uses of oxytocin, substance use disorders, physician impairment, the assessment of childhood trauma, and multiple aspects of attachment theory.

Kristy Lamb

Kristy Lamb, MD, is dual boarded in Family Medicine and Psychiatry and is the president and CEO of BOLD Health, Inc. in San Diego, CA and an assistant professor in the Department of Family Medicine and Public Health at UC San Diego Medical school in San Diego, CA. She assisted with the study's design, literature review, and in participant recruitment. Her research interests are in opiate dependence, psychodynamic psychotherapy and the integration of mental health and primary care.

Michael L. Thomas

Michael L. Thomas, PhD, is an Assistant Research Scientist in the Department of Psychiatry at the University of California, San Diego. He served as the main statistical consultant for the project, assisted in the analysis of the study data, and edited the manuscript. Dr. Thomas’ research and clinical interests include psychometrics, neuroimaging, and schizophrenia.

Wendy Khentigan

Wendy Khentigan, MD, is a psychiatrist in private practice in Encinitas, CA, is currently Board Certified by the American Board of Psychiatry, and is a Distinguished Fellow of the American Psychiatric Association. She assisted with the study's design, literature review, and in participant recruitment. Her research interests include best physician prescribing practices, addiction and community health problems.