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Physicians’ Decision-making When Implementing Buprenorphine With New Patients: Conjoint Analyses of Data From a Cohort of Current Prescribers

Knudsen, Hannah, K., PhD; Lofwall, Michelle, R., MD; Walsh, Sharon, L., PhD; Havens, Jennifer, R., PhD; Studts, Jamie, L., PhD

doi: 10.1097/ADM.0000000000000360
Original Research

Objectives: Few studies have considered how providers make decisions to prescribe buprenorphine to new patients with opioid use disorder. This study examined the relative importance of patients’ clinical, financial, and social characteristics on physicians’ decision-making related to willingness to prescribe buprenorphine to new patients and the number of weeks of medication that they are willing to initially prescribe after induction.

Methods: A national sample of 1174 current prescribers was surveyed. Respondents rated willingness to prescribe on a 0 to 10 scale and indicated the number of weeks of medication (ranging from none to >4 weeks) for 20 hypothetical patients. Conjoint analysis estimated relative importance scores and part-worth utilities for these 2 outcome ratings.

Results: The mean rating for willingness to prescribe was 5.52 (SD 2.47), indicating a moderate willingness to implement buprenorphine treatment. The mean prescription length was 2.06 (SD 1.34), which corresponds to 1 week of medication. For both ratings, the largest importance scores were for other risky substance use, method of payment, and spousal involvement in treatment. Illicit benzodiazepine use, having Medicaid insurance to pay for the office visit, and having an opioid-using spouse were negatively associated with these outcome ratings, whereas a history of no risky alcohol or benzodiazepine use, cash payment, and having an abstinent spouse were positively associated with both ratings.

Conclusions: Reticence to prescribe to individuals using an illicit benzodiazepine and individuals with a drug-using spouse aligns with practice guidelines. However, reluctance to prescribe to patients with Medicaid may hamper efforts to expand access to treatment.

Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY (HKK, MRL, SLW, JRH); and Department of Behavioral Science, University of Kentucky, Lexington, KY (JLS).

Send correspondence to Hannah K. Knudsen, Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Ave, Room 204, Lexington, KY 40508. E-mail:

Received 10 March, 2017

Accepted 29 August, 2017

Funding: This study was supported by a grant from the National Institute on Drug Abuse (NIDA Grant R33DA035641). NIDA had no further role in study design; in the collection, analysis, or interpretation of data; or the preparation of this manuscript. The study team's use of REDCap was supported by a grant from the National Center for Advancing Translational Sciences (NIH CTSA UL1TR000117) that supports the University of Kentucky's Center for Clinical and Translational Science. The content of this manuscript is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health or NIDA.

Conflicts of interest: MRL has received contract research funding from Braeburn Pharmaceuticals, has provided consultation for Invidior (which manufactures Suboxone, a buprenorphine product), and has received honoraria from PCM Scientific, which received unrestricted educational grant funds from Reckitt Benckiser (now Invidior) for developing and delivering educational talks on opioid use disorder. SLW has received consulting fees and research support from Braeburn Pharmaceuticals, consulting fees from Camurus, honoraria and travel support from Indivior, and honoraria from PCM Scientific, through an unrestricted educational grant from Reckitt Benckiser, as a speaker and conference organizer. JRH has received honoraria from Pinney Associates for serving on an external advisory board focused on buprenorphine misuse and diversion. The remaining authors (HKK and JLS) have no conflicts of interest to declare.

© 2018 American Society of Addiction Medicine