2012 220-149 Opioid Treatment Sub-Study 1.2: Key Informant Survey of the Adoption of Innovation: Focus on the use of Buprenorphine-Containing Medications in Opioid Treatment Programs in Florida

Publication Date: September 2012

Description:

Extant literature indicates the effectiveness of buprenorphine for the treatment of opioid dependence (Amass, Ling, Freese, Reiber, Annon, Cohen, et al., 2004; Fischer, Gombas, Eder, Jagsch, Peternell, Stuhlinger, et al., 1999). Findings from community based treatment settings indicate that buprenorphine-containing medications can be adopted into existing treatment regimens (Amass et al., 2004). The Substance Abuse and Mental Health Service Administration (SAMHSA) has published guidelines and recommendations for its utilization across treatment settings (SAMSHA, 2004). Despite these findings and efforts to encourage greater clinical use, the adoption of buprenorphine for the treatment of opioid dependence has been limited (Ducharme, Knudsen, Roman, & Johnson, 2007; Knudsen, Ducharme, & Roman, 2006; Knudsen, Ducharme, & Roman, 2007).

Analyses for this investigation focused on provider impressions regarding the use of buprenorphine-containing medications in routine practice within publicly-funded medication assisted treatment (MAT) settings. Forty-five professionals in 12 counties in Florida who make clinical and/or administrative decisions regarding service delivery in OTPs responded to a webbased survey inquiring about their programs': (1) historical use of buprenorphine-containing medications, (2) barriers to the use of buprenorphine-containing medications, (3) efficacy of these alternative medications, and (4) strategies and challenges in the adoption of innovation.

Findings from this investigation indicate that treatment providers across Florida recognize buprenorphine-containing medications as safe and effective alternatives to methadone for the treatment of opioid dependence. An examination of predictors of adoption of innovation indicate that Florida MATs are supportive of innovation and a majority of key informants report receiving training on buprenorphine-containing medication to staff. Although key informants report that their MAT can and will prescribe buprenorphine-containing medications, they acknowledge that buprenorphine is 'rarely' used. While staff reported some training exposure, they overwhelmingly (88%) endorsed an item indicating that additional training is desired.

Overwhelmingly, key informants report that the increased personal cost to clients hinders the utilization of buprenorphine in publicly-funded MATs. Little collaboration with communitybased physicians who may prescribe these medications was noted. The reduced dosing schedule that may be employed with buprenorphine-containing could reduce burden (to the individual) and costs (for transportation and staff time), but has not been a motivating factor in its use. State and local funders must place greater emphasis on creating affordable avenues for clients to obtain buprenorphine-containing medication in publicly funded treatment settings. Additional staff training will likely be required to insure that this change process occurs, if financial barriers are removed.