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Substance Abuse Treatment, Prevention, and Policy
Published in: Substance Abuse Treatment, Prevention, and Policy 1/2015

Open Access 01-12-2015 | Research

Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio

Authors: Todd Molfenter, Carol Sherbeck, Mark Zehner, Andy Quanbeck, Dennis McCarty, Jee-Seon Kim, Sandy Starr

Published in: Substance Abuse Treatment, Prevention, and Policy | Issue 1/2015

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Abstract

Background

Buprenorphine is under-utilized in treating opioid addiction. Payers and providers both have substantial influence over the adoption and use of this medication to enhance recovery. Their views could provide insights into the barriers and facilitators in buprenorphine adoption.

Methods

We conducted individual interviews with 18 Ohio county Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Boards (payers) and 36 addiction treatment centers (providers) to examine barriers and facilitators to buprenorphine use. Transcripts were reviewed, coded, and qualitatively analyzed. First, we examined reasons that county boards supported buprenorphine use. A second analysis compared county boards and addiction treatment providers on perceived barriers and facilitators to buprenorphine use. The final analysis compared county boards with low and high use of buprenorphine to determine how facilitators and barriers differed between those settings.

Results

County boards (payers) promoted buprenorphine use to improve clinical care, reduce opioid overdose deaths, and prepare providers for participation in integrated models of health care delivery with primary care clinics and hospitals. Providers and payers shared many of the same perceptions of facilitators and barriers to buprenorphine use. Common facilitators identified were knowledge of buprenorphine benefits, funds allocated to purchase buprenorphine, and support from the criminal justice system. Common barriers were negative attitudes toward use of agonist pharmacotherapy, payment environment, and physician prescribing capacity. County boards with low buprenorphine use rates cited negative attitudes toward use of agonist medication as a primary barrier. County boards with high rates of buprenorphine use dedicated funds to purchase buprenorphine in spite of concerns about limited physician prescribing capacity.

Conclusions

This qualitative analysis found that attitudes toward use of medication and medication funding environment play important roles in an organization’s decision to begin buprenorphine use and that physician availability influences an organization’s ability to expand buprenorphine use over time.
Additional education, reimbursement support, and policy changes are needed to support buprenorphine adoption and use, along with a greater understanding of the roles payers, providers, and regulators play in the adoption of targeted practices.
Literature
1.
Greenwald MK, Johanson C, Moody DE, Woods JH, Kilbourn MR, Koeppe A, et al. Effects of buprenorphine maintenance dose on mu-opioid receptor availability, plasma concentrations, and antagonist blockade in heroin-dependent volunteers. Neuropsychopharmacology. 2003;28(11):2000–9.CrossRefPubMed
2.
Stoller KB, Bigelow GE, Walsh SL, Strain EC. Effects of buprenorphine/naloxone in opioid-dependent humans. Psychopharmacology. 2001;154(3):230–42.CrossRefPubMed
3.
Berglund M. A better widget? Three lessons for improving addiction treatment from a meta‐analytical study. Addiction. 2005;100(6):742–50.CrossRefPubMed
4.
Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;2.
5.
Ling W, Wesson DR. Clinical efficacy of buprenorphine: comparisons to methadone and placebo. Drug Alcohol Depend. 2003;70(2):S49–57.CrossRefPubMed
6.
Fiellin DA. The first three years of buprenorphine in the United States: experience to date and future directions. J Addict Med. 2007;1(2):62–7.CrossRefPubMed
7.
Substance Abuse and Mental Health Services Administration (SAMHSA). The N-SSATS Report: Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003 to 2011. 2013: Rockville, MD.
8.
Knudsen HK, Abraham AJ. Perceptions of the state policy environment and adoption of medications in the treatment of substance use disorders. Psychiatr Serv. 2012;63(1):19–25.CrossRefPubMedCentralPubMed
9.
Ducharme LJ, Abraham AJ. State policy influence on the early diffusion of buprenorphine in community treatment programs. Subst Abuse Treat Prev Policy. 2008;3(1):17.CrossRefPubMedCentralPubMed
10.
Molfenter T, McCarty D, Capoccia V, Gustafson D. Development of a Multilevel Framework to Increase Use of Targeted Evidence-Based Practices in Addiction Treatment Clinics. Public Health Front. 2013;2(1):11–20.CrossRefPubMedCentralPubMed
11.
Heinrich CJ, Cummings GR. Adoption and Diffusion of Evidence‐Based Addiction Medications in Substance Abuse Treatment. Health Serv Res. 2014;49(1):127–52.CrossRefPubMedCentralPubMed
12.
Andrews CM, D’Aunno TA, Pollack HA, Friedmann PD. Adoption of Evidence-Based Clinical Innovations: The Case of Buprenorphine Use by Opioid Treatment Programs. Med Care Res Rev. 2014;71:46–60.CrossRef
13.
Ducharme LJ, Knudsen HK, Roman PM, Johnson JA. Innovation adoption in substance abuse treatment: Exposure, trialability, and the Clinical Trials Network. J Subst Abus Treat. 2007;32(4):321–9.CrossRef
14.
Knudsen HK, Ducharme LJ, Roman PM. Early adoption of buprenorphine in substance abuse treatment centers: data from the private and public sectors. J Subst Abus Treat. 2006;30(4):363–73.CrossRef
15.
Knudsen HK, Abraham AJ, Oser CB. Barriers to the implementation of medication-assisted treatment for substance use disorders: The importance of funding policies and medical infrastructure. Eval Program Plann. 2011;34(4):375–81.CrossRefPubMedCentralPubMed
16.
Fuller BE, Rieckmann T, McCarty D, Smith KW, Levine H. Adoption of naltrexone to treat alcohol dependence. J Subst Abus Treat. 2005;28(3):273–80.CrossRef
17.
Koch AL, Arfken CL, Schuster CR. Characteristics of US substance abuse treatment facilities adopting buprenorphine in its initial stage of availability. Drug Alcohol Depend. 2006;83(3):274–8.CrossRefPubMed
18.
Horgan CM, Reif S, Hodgin D, Garnick DW, Merrick EL. Availability of addiction medications in private health plans. J Subst Abus Treat. 2008;34(2):147–56.CrossRef
19.
Schroeder SA. An agenda to combat substance abuse. Health Aff. 2005;24(4):1005–13.CrossRef
20.
21.
Centers for Disease Control (CDC). DATA2010: The Healthy People 2010 Database. Atlanta, GA: National Center for Health Statistics; 2011.
22.
Ohio Department of Health, O.o.V.S. 2011 Ohio Drug Overdose Data: General Findings. 2011.
23.
Sherba RT, Massatti RR, Potts L, Adhikari SB, Martt N, Starr S, et al. A Review of Ohio’s Treatment Capacity in Addressing the State’s Opiate Epidemic. J Drug Policy Anal. 2012;5(1):1–11.CrossRef
24.
Nicholls L, Bragaw L, Ruetsch C. Opioid dependence treatment and guidelines. J Manag Care Pharm. 2010;16(1 Suppl B):S14–21.PubMed
25.
26.
Molfenter T, Kim J, Quanbeck A, Patel-Porter T, Starr S, McCarty D. Testing use of payers to facilitate evidence-based practice adoption: protocol for a cluster-randomized trial. Implement Sci. 2013;8(1):50.CrossRefPubMedCentralPubMed
27.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMed
28.
ATLAS.ti, Version 6.1.16. 2011, Scientific Software Development.
29.
Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval. 2006;27(2):237–46.CrossRef
30.
31.
Massatti R, Beeghly C, Hall O, Kariisa M, Potts L. Increasing heroin overdoses in Ohio: understanding the issue. Columbus, OH: Ohio Department of Mental Health and Addiction Services; 2014.
32.
Forrest CB, Villagra VV, Pope JE. Managing the metric vs managing the patient: the physician’s view of pay for performance. Am J Manag Care. 2006;12(2):83–5.PubMed
33.
Higashi T, Wenger NS, Adams JL, Fung C, Roland M, McGlynn EA, et al. Relationship between number of medical conditions and quality of care. N Engl J Med. 2007;356(24):2496–504.CrossRefPubMed
34.
Knudsen HK, DuCharme LJ, Roman PM, Link T. Buprenorphine diffusion: The attitudes of substance abuse treatment counselors. J Subst Abus Treat. 2005;29(2):95–106.CrossRef
35.
Veilleux JC, Colvin PJ, Anderson J, York C, Heinz AJ. A review of opioid dependence treatment: pharmacological and psychosocial interventions to treat opioid addiction. Clin Psychol Rev. 2010;30(2):155–66.CrossRefPubMed
36.
Fudala PJ, Bridge TP, Herbert S, Williford WO, Chiang N, Jones K, et al. Office-based treatment of opiate addiction with a sublingual-tablet formulation of buprenorphine and naloxone. N Engl J Med. 2003;349(10):949–58.CrossRefPubMed
37.
Cunningham CO, Kunis HV, Roose RJ, Elam RT, Sohler NL. Barriers to obtaining waivers to prescribe buprenorphine for opioid addiction treatment among HIV physicians. J Gen Intern Med. 2007;22(9):1325–9.CrossRefPubMedCentralPubMed
38.
Hutchinson E, Catlin M, Andrilla HA, Baldwin L, Rosenblatt RA. Barriers to primary care physicians prescribing buprenorphine. Ann Fam Med. 2014;12(2):128–33.CrossRefPubMedCentralPubMed
39.
Walley AY, Alperen JK, Cheng DM, Botticelli M, Castro-Donlan C, Samet JH, et al. Office-based management of opioid dependence with buprenorphine: clinical practices and barriers. J Gen Intern Med. 2008;23(9):1393–8.CrossRefPubMedCentralPubMed
40.
41.
Rabin BA, Brownson R, Haire-Joshua D, Kreuter MW, Weaver NL. A glossary for dissemination and implementation research in health. J Public Health Manag Pract. 2008;14(2):117–23.CrossRefPubMed
42.
Rieckmann T, Daley M, Fuller BE, Thomas CP, McCarty D. Client and counselor attitudes toward the use of medications for treatment of opioid dependence. J Subst Abus Treat. 2007;32(2):207–15.CrossRef
43.
Arfken CL, Johanson C, Menza S, Schuster R. Expanding treatment capacity for opioid dependence with office-based treatment with buprenorphine: National surveys of physicians. J Subst Abus Treat. 2010;39(2):96–104.CrossRef
44.
Wood E, Samet JH, Volkow ND. Physician education in addiction medicine. Jama. 2013;310(16):1673–4.CrossRefPubMed
45.
Kennedy J, Dipzinski A, Roll J, Coyne J, Blodgett E. Medicare prescription drug plan coverage of pharmacotherapies for opioid and alcohol dependence in WA. Drug Alcohol Depend. 2011;114(2):201–6.PubMed
Metadata
Title
Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio
Authors
Todd Molfenter
Carol Sherbeck
Mark Zehner
Andy Quanbeck
Dennis McCarty
Jee-Seon Kim
Sandy Starr
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Substance Abuse Treatment, Prevention, and Policy / Issue 1/2015
Electronic ISSN: 1747-597X
DOI
https://doi.org/10.1186/s13011-015-0009-2

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