Medication Can Help, But How Do We Get Providers & Policy Makers to Implement It?

Although there is an established evidence base for buprenorphine/naloxone (Suboxone) in the treatment of patients with opioid use disorder, adoption of this specific medication-assisted treatment has been mixed, particularly in publically funded programs.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Little is known about attitudes regarding Suboxone among key stakeholders in its adoption, including policy makers and providers, and how these attitudes might act as barriers or facilitators of its implementation.

HOW WAS THIS STUDY CONDUCTED?

As part of a larger trial to increase use of Suboxone in publically funded community programs in Ohio, authors used qualitative analyses to assess perceived barriers and facilitators of implementing medication-assisted treatment with Suboxone. Participants were 18 policy makers and 36 treatment providers representing the same number of “county boards” and treatment programs, respectively.

Specifically, in Ohio, publically funded treatment is administered by local, or county, boards that are responsible for funding programs located in 1 to 5 counties. The analyses included use of qualitative analysis software and review by members of the research team to develop a coding scheme and re-review to code the interviews into primary themes.

WHAT DID THIS STUDY FIND?

Factors that were more likely to result in the adoption and implementation of Suboxone were:

general knowledge about the treatment approach among clinicians
the potential ability of the criminal justice system to link patients with Suboxone treatment
the importance of funding specifically set aside for Suboxone treatment

Although response themes were generally similar among board members and providers, providers also emphasized the importance of having access to supportive physicians (i.e., prescribers).

Barriers to implementing Suboxone treatment were:

negative attitudes about agonist medications
lack of expertise
limited availability of prescribers
insufficient funding
concerns that patients will divert (sell) the medication

In comparing county boards with relatively modest versus greater adoption of Suboxone at the time of study, those with lower levels of adoption had concerns about providers’ negative attitudes, particularly as related to the 12-step mutual-help orientation of programs and the community resources to which they link patients.

The study provides insights into both policy makers’ and providers’ perceptions of Suboxone. These insights may help inform efforts to enhance the dissemination of medication-assisted treatment through sufficiently addressing these concerns.

WHY IS THIS STUDY IMPORTANT?

The study constitutes an example of how research can assess attitudes of crucial decision-makers in both clinical and policy making roles to inform best practices in the community implementation of an evidence-based substance use disorder (SUD) treatment approach.

This study represents a potentially useful approach for other state and local agencies to assess attitudes of key decision-makers. The data derived from such assessments could offer important insights that might facilitate more effective dissemination efforts that are more sensitive to the needs of both providers and policy makers.

LIMITATIONS

Only one member from each participating board and a single decision maker from each participating treatment program participated in qualitative analyses. Thus, it is unclear whether their data are representative of the agencies they work for.

NEXT STEPS

Given that the current study was conducted among publically funded programs in Ohio, other local and state agencies may wish to fund similar research in an effort to address the growing opioid problem and reduce the public health and safety burden in their communities.

BOTTOM LINE

For individuals & families seeking recovery: Not all treatment programs may have Suboxone available. It may be helpful to ask programs directly whether they offer medication-assisted treatment with Suboxone.
For scientists: More research is needed to understand the attitudes of key decision-makers at both the policy and treatment program levels to inform best practices in dissemination of Suboxone treatment into existing care.
For policy makers: Consider participating in research that assesses perceived barriers and facilitators of implementing evidence-based practices in community settings.
For treatment professionals and treatment systems: Self-assessment and staff discussions about Suboxone adoption and implementation might lead to insights about the use of medication-assisted treatment in your agency. Also, consider participating in research that assesses perceived barriers and facilitators of implementing evidence-based practices in community settings.

CITATIONS

Molfenter, T., Sherbeck, C., Zehner, M., Quanbeck, A., McCarty, D., Kim, J. S., & Starr, S. (2015). Implementing buprenorphine in addiction treatment: payer and provider perspectives in Ohio. Subst Abuse Treat Prev Policy, 10, 13. doi: 10.1186/s13011-015-0009-2