Lewei Allison Lin1, Michelle R Lofwall2, Sharon L Walsh2, Adam J Gordon3, Hannah K Knudsen2. 1. University of Michigan, Department of Psychiatry, 2800 Plymouth Road, Ann Arbor, MI 48109, USA; VA Center for Clinical Management Research (CCMR), Department of Veterans Affairs Healthcare System, 2800 Plymouth Rd., Ann Arbor, MI 48109, USA. Electronic address: leweil@med.umich.edu. 2. University of Kentucky, Department of Behavioral Science and Center on Drug and Alcohol Research, 845 Angliana Avenue, Lexington, KY 40508, USA. 3. University of Utah, Division of Epidemiology, Department of Medicine, 295 Chipeta Way, Salt Lake City UT 84132, USA; VA Salt Lake City Health Care System, Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0) and Section of Addiction Medicine, 500 Foothill Drive, Salt Lake City, UT 84148, USA.
Abstract
BACKGROUND: While there has been a dramatic increase in prescribing of buprenorphine for the treatment of opioid use disorder in the US, little is known about prescribers' attitudes and practices regarding buprenorphine diversion and how they relate to prescriber characteristics. METHODS: A national random sample of buprenorphine prescribers (N = 1174) completed surveys from July 2014 to January 2017. Analyses examined relationships between prescriber and practice characteristics and prescriber perceptions and approaches regarding diversion. RESULTS: Among this sample of buprenorphine prescribers, 79.0% (N = 898) reported assessing all patients for risk of buprenorphine diversion and misuse. A third of prescribers described diversion as a significant or very significant concern in their community. The majority of prescribers reported seeing patients on average at least every other week during the first 60 days of treatment, and the majority reported testing urine for buprenorphine to assess for diversion. Perceptions of diversion being a greater problem in their community (AOR 1.212, 95% CI 1.073-1.369) and use of medication counts (AOR 1.006, 95% CI 1.003-1.009) were associated with increased likelihood of terminating patients when diversion was suspected, while having expertise in addiction (AOR 0.526, 95% CI 0.406-0.682) or psychiatry (AOR 0.714, 95% CI 0.558-0.914) were associated with decreased odds of terminating treatment for suspected diversion. CONCLUSIONS: Buprenorphine prescribers report diversion is an important issue, and most prescribers report that they assess patients for diversion, though specific practices differ based on prescriber and practice characteristics. Published by Elsevier B.V.
BACKGROUND: While there has been a dramatic increase in prescribing of buprenorphine for the treatment of opioid use disorder in the US, little is known about prescribers' attitudes and practices regarding buprenorphine diversion and how they relate to prescriber characteristics. METHODS: A national random sample of buprenorphine prescribers (N = 1174) completed surveys from July 2014 to January 2017. Analyses examined relationships between prescriber and practice characteristics and prescriber perceptions and approaches regarding diversion. RESULTS: Among this sample of buprenorphine prescribers, 79.0% (N = 898) reported assessing all patients for risk of buprenorphine diversion and misuse. A third of prescribers described diversion as a significant or very significant concern in their community. The majority of prescribers reported seeing patients on average at least every other week during the first 60 days of treatment, and the majority reported testing urine for buprenorphine to assess for diversion. Perceptions of diversion being a greater problem in their community (AOR 1.212, 95% CI 1.073-1.369) and use of medication counts (AOR 1.006, 95% CI 1.003-1.009) were associated with increased likelihood of terminating patients when diversion was suspected, while having expertise in addiction (AOR 0.526, 95% CI 0.406-0.682) or psychiatry (AOR 0.714, 95% CI 0.558-0.914) were associated with decreased odds of terminating treatment for suspected diversion. CONCLUSIONS:Buprenorphine prescribers report diversion is an important issue, and most prescribers report that they assess patients for diversion, though specific practices differ based on prescriber and practice characteristics. Published by Elsevier B.V.
Entities:
Keywords:
Buprenorphine; Diversion; Opioid use disorder; Providers; Treatment
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