More than half of rural counties in the United States lack a physician trained and waivered by the Drug Enforcement Agency to treat opioid use disorder using Buprenorphine Maintenance Treatment. Furthermore, many physicians with a waiver are not using it fully or at all. Rural waivered physicians participating in a national survey (n=1124) reported a range of concerns about prescribing buprenorphine including medication misuse, time constraints, and lack of available mental health or psychosocial support services.
Waivered physicians who don't currently prescribe buprenorphine or have never done so (n = 321) were more likely than current prescribers to report the following barriers: time constraints, lack of patient need, resistance from practice partners, lack of specialty backup for complex problems, lack of confidence in their ability to manage opioid use disorder, concerns about Drug Enforcement Agency intrusions on their practice, and attraction of drug users to their practice. Physicians reporting other barriers (n=205) described administrative or infrastructure issues (told they cannot do it, don't have the space or staff) (18 percent), regulatory hurdles (including prior authorization and paperwork) (17 percent), difficult patients (12 percent), and stigma (9 percent). The study authors call for tailored strategies to address barriers to providing Buprenorphine Maintenance Treatment and to support physicians in adding or maintaining this service.