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Pharmacotherapy, Resource Needs, and Physician Recruitment Practices in Substance Use Disorder Treatment Programs

Knudsen, Hannah K., PhD; Brown, Randy, MD, PhD; Jacobson, Nora, PhD; Horst, Julie, MBA; Kim, Jee-Seon, PhD; Collier, Elizabeth, MSW; Starr, Sanford, MSW; Madden, Lynn M., PhD, MPA; Haram, Eric, BS, LADC; Molfenter, Todd, PhD

doi: 10.1097/ADM.0000000000000441
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Objectives: Effective pharmacological treatments for opioid use disorder (OUD) continue to be underutilized, particularly within specialty substance use disorder (SUD) treatment organizations. Few studies have examined whether specific practices to recruit prescribers, financial needs, and human resource needs facilitate or impede the implementation of pharmacotherapy.

Methods: Surveys were completed by administrators from 160 treatment programs in Florida, Ohio, and Wisconsin. Respondents described availability of five pharmacotherapies for treating OUD, organizational resource needs, current use of physician recruitment practices, and buprenorphine treatment slots.

Results: The mostly commonly available medications were injectable naltrexone (65.4%; n = 102), buprenorphine-naloxone (55.7%; n = 88), and tablet naltrexone (50.0%; n = 78). Adopters of each of the 5 pharmacotherapies reported significantly greater physician outreach than organizations that did not provide these medications. The mean number of buprenorphine slots was 94.1 (SD 205.9). There were unique correlates of adoption (ie, any slots) and availability (number of slots) of buprenorphine. Physician outreach activities were correlated with the likelihood of nonadoption, whereas medical resource needs (ie, needing more physicians to prescribe pharmacotherapy) and dedicated resources for physician recruitment were associated with the number of slots.

Conclusions: Physician recruitment activities differentiated those organizations that had existing pharmacotherapy treatment capacity (ie, any slots) from those that had no capacity. Efforts to address the medical resource needs of treatment organizations, and also strategies that encourage organizations to devote resources to recruiting prescribers may hold promise for increasing access to these lifesaving treatments.

University of Kentucky, Department of Behavioral Science and Center on Drug and Alcohol Research, Lexington, KY (HKK); University of Wisconsin-Madison, Department of Family Medicine and Community Health, Madison, WI (RB); University of Wisconsin-Madison, Institute for Clinical and Translational Research, Madison, WI (NJ); University of Wisconsin-Madison, Department of Industrial and Systems Engineering, Madison, WI (JH, TM); University of Wisconsin-Madison, Department of Educational Psychology, Madison, WI (J-SK); Wisconsin Department of Health Services, Madison, WI (EC); Ohio Department of Mental Health and Addiction Services, Columbus, OH (SS); APT Foundation, New Haven, CT (LMM); Haram Consulting, Bowdoinham, ME (EH).

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

Received 7 November, 2017

Accepted 14 May, 2018

Funding: This study was funded by the National Institute on Drug Abuse (NIDA Grant R01DA041415). NIDA has played no role in the study design or preparation of this manuscript. The authors are solely responsible for the content of this manuscript, which does not represent the official views of the National Institutes of Health or NIDA.

The authors declare no competing interests.

© 2019 American Society of Addiction Medicine