Health Care Providers and Medication-Assisted Treatment: Examining Reasons for Not Prescribing

Background and Purpose: Medication-assisted treatment (MAT) is considered to be the standard of care for moderate to severe opioid use disorders (OUD). MAT reduces opioid cravings and withdrawal symptoms, decreases illicit opioid use, and lowers rates of premature death often seen in those with OUD. MAT remains critically underutilized and reasons for not prescribing are ubiquitous. Ultimately, there is a lack of knowledge related to MAT prescribing practices. To examine the phenomena, we posed the following research question: What is the association between reasons for not prescribing, offering referral and the act of prescribing.

Methods: Primary data collection of 252 surveys were part of a statewide effort to examine health care provider perceptions of MAT from May to June 2018. This study was a preliminary effort to determine the barriers associated with health care providers’ use of, and referral to, MAT for patients who have OUD. There were nine reasons for not prescribing (e.g., not within their scope of practice, do not want to be known as an “addict doctor,” not adequately prepared to treat OUD, no time to add more patients) and two binary outcomes (i.e., referral and prescription). We used Bayesian logistic regression methods with non-informative prior distributions for all regression coefficients. Our models contained predictor variables related to providers’ profession, place of work, license status for Substance Abuse and Mental Health Services Administration (SAMHSA) waiver to prescribe buprenorphine, and reasons for not prescribing MAT.

Results: Providers who worked at agencies that prescribe medication to treat OUD or who had a SAMHSA waiver to prescribe buprenorphine were more likely to make at least one MAT referral and to prescribe MAT at least once. Providers’ profession (e.g., physician, nurse practitioner) did not impact likelihood of making MAT referrals. However, physicians were more likely to prescribe MAT than nurse practitioners. Providers working at acute care settings were more likely to prescribe MAT, but were less likely to make MAT referrals, when compared to providers working at ambulatory non-emergent care settings. Providers who did not feel adequately prepared to treat OUD were less likely to prescribe MAT.

Conclusions and Implications: Reasons for not prescribing are critical considerations for providers even if they are part of a practice that encourages and validates MAT prescribing. Findings have profound implications for the use of MAT to combat the opioid epidemic, indicating opportunities for intervention through targeted provider education. Given our findings, we offer specific recommendations for primary care workforce development and reducing MAT-related stigma.