NIDA Clinical Trials Network: Examples of community program buprenorphine dissemination in low-access areas.

Knudsen and colleagues (2009) described adoption of buprenorphine treatment (BUP) doubling in community-based treatment programs (CTPs) within the National Drug Abuse Treatment Clinical Trials Network (CTN) during the first two years of CTP participation (2002-2004) regardless of whether or not CTPs participated directly in a buprenorphine protocol, supporting community partnerships for accelerating dissemination of evidence-based practices. Barriers to wider buprenorphine dissemination persist; availability may be limited by physician access, patient characteristics, attitudinal or institutional factors, state/local policies, and Medicaid reimbursement. This poster reports on two CTP physicians’ efforts to introduce or expand BUP in communities where access to BUP was limited.

IRB approval was obtained for a 13-item self-report telephone interview with two CTP physician site PIs who participated in a CTN buprenorphine protocol and later successfully sustained expanded access to BUP in CTPs with barriers of rural location and/or few qualified buprenorphine-prescribing physicians. The interview was designed and conducted by another CTP physician who participated in CTN buprenorphine protocols. Both physicians reported: 1) high local prevalence of opioid dependence, especially among youth; 2) mostly maintenance treatment in adults and youth; 3) local resistance to BUP in youth despite evidence supporting better outcomes; 4) cost of treatment and poor reimbursement by state Medicaid insurances as the main barrier to patient access and physician/program adoption. In conclusion, it appears that lack of insurance reimbursement and prevailing community beliefs regarding buprenorphine maintenance for opioid dependence (particularly for youth) remain barriers to wider practice dissemination.