Even when physicians, nurse practitioners (NPs), and physician assistants (PAs) are willing to prescribe buprenorphine for the treatment of opioid use disorder (OUD), numerous barriers can make it hard for them to get started, including a general lack of education and training, lack of institutional support, poor coordination of care/community-based addiction treatment resources, limited time availability, and insurance obstacles (such as requiring prior authorization).
Until very recently, most medical, NP, and PA schools offered little (or no) addiction education, and even fewer had opportunities for students to complete rotations in addiction medicine. Since most of medical education is delivered via an apprenticeship model, this gap in education meant many medical clinicians graduated without ever having observed buprenorphine prescribing in medical practice. While classroom or lecture-style education is helpful in obtaining the knowledge to prescribe the medication, that alone is often insufficient.
Ways to support medical clinicians new to prescribing:
Clinical Shadowing – It can be helpful for clinicians to shadow a peer who has a robust buprenorphine practice. This opportunity allows the clinician to observe patient interactions, clinical workflows, and ask questions along the way. This can be done in your own clinic or may be possible at other clinics in your region.
Individual Mentorship – The Providers Clinical Support System (PCSS), which is run by the American Academy of Addiction Psychiatry and funded by the Substance Abuse and Mental Health Administration (SAMHSA), helps individuals link with mentors in addiction medicine. Additional information can be found at the PCSS website.
National Addiction Medicine Meeting Attendance – National meetings can be a great way to meet peers, identify mentors, and learn more about addiction medicine in primary care. Examples of such meetings include the annual conferences of the American Society of Addiction Medicine and the Association for Multidisciplinary Education and Research in Substance Use and Addiction.
Real-Time Clinical Decision Support – The National Clinician Consultation Center (NCCC) offers clinician-to-clinician telephone consultation for primary care clinicians through the Substance Use Warmline at 855-300-3595. Consultation is available Monday through Friday, between 9 a.m. and 8 p.m. ET, from addiction medicine-certified physicians, clinical pharmacists, and nurses with special expertise in pharmacotherapy options for opioid use.
Additional Continuing Medical Education (CME) Days and Funding – Offering additional funds, blocked clinical time, or additional CME days specifically to participate in addiction medicine mentorship, shadowing, or conferences can incentivize clinicians who are on the fence about prescribing buprenorphine for OUD.
Prior Authorization Supports – If prior authorization is frequently required for buprenorphine by your payers, ensure that systems are set up to minimize the burden on the prescriber. An example strategy would be having other staff (e.g., nurses or medical assistants) complete the majority of the paperwork, with the prescriber reviewing and signing off.
Make the First Patient a Success – One way to scaffold newer buprenorphine prescriber success is having the start with a more stable patient. For example, this could be someone who is being transferred from another clinician in your practice or coming out of a longer residential stay.