Implementing buprenorphine in addiction treatment: Payer and provider perspectives in Ohio

Background: Buprenorphine is under-utilized in treating opioid addiction. Payers and providers both have substantial influence over the adoption and use of this medication to enhance recovery. Their views could provide insights into the barriers and facilitators in buprenorphine adoption. Methods: We conducted individual interviews with 18 Ohio county Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Boards (payers) and 36 addiction treatment centers (providers) to examine barriers and facilitators to buprenorphine use. Transcripts were reviewed, coded, and qualitatively analyzed. First, we examined reasons that county boards supported buprenorphine use. A second analysis compared county boards and addiction treatment providers on perceived barriers and facilitators to buprenorphine use. The final analysis compared county boards with low and high use of buprenorphine to determine how facilitators and barriers differed between those settings. Results: County boards (payers) promoted buprenorphine use to improve clinical care, reduce opioid overdose deaths, and prepare providers for participation in integrated models of health care delivery with primary care clinics and hospitals. Providers and payers shared many of the same perceptions of facilitators and barriers to buprenorphine use. Common facilitators identified were knowledge of buprenorphine benefits, funds allocated to purchase buprenorphine, and support from the criminal justice system. Common barriers were negative attitudes toward use of agonist pharmacotherapy, payment environment, and physician prescribing capacity. County boards with low buprenorphine use rates cited negative attitudes toward use of agonist medication as a primary barrier. County boards with high rates of buprenorphine use dedicated funds to purchase buprenorphine in spite of concerns about limited physician prescribing capacity. Conclusions: This qualitative analysis found that attitudes toward use of medication and medication funding environment play important roles in an organization's decision to begin buprenorphine use and that physician availability influences an organization's ability to expand buprenorphine use over time.