In the Journals

Few early career family physicians feel prepared to provide buprenorphine treatment

Just 10% of early career certified family physicians felt ready to provide buprenorphine treatment for opioid use, according to 2016 National Family Medicine Graduate Survey findings recently published in Annals of Family Medicine.

Many have called for increasing access to buprenorphine. A recent study, however, reported that only 28.6% of family medicine residencies have a required addiction medicine curriculum, and only 31.2% had at least one graduate obtain a waiver to prescribe buprenorphine in the past year,” Sebastian T. Tong, MPH, MD, of the department of family medicine and population health at Virginia Commonwealth University and colleagues wrote.

Researchers reviewed 1,979 responses from the 2016 National Family Medicine Graduate Survey to assess preparedness of the family physicians who completed their residency in 2013.

Tong and colleagues found 10% reported being adequately trained during residency to provide buprenorphine treatment and 7% reported providing buprenorphine treatment in their current practice. Of the latter group, 45.6% said this preparedness came as a result of their residency.

Being prepared

Darlene Petersen, MD, a family medicine practitioner in Utah who was not affiliated with the study, said she felt prepared to give buprenorphine treatment to patients with opioid use disorder early in her career.

She told Healio Family Medicine her turning point in recognizing the significance of having such a skill came during her first year of residency when she had a patient with chronic migraines and opioid use disorder that she was struggling to treat.

“At this point, my mentor sat me down and said, ‘You can either get the tools and training you need now, because you are going to have these patients throughout your career, or you can continue to be frustrated that you can’t help,’” she said.

While her mentor monitored how she handled patients, Petersen said she took online courses and reviewed tools available through the American Society of Addiction Medicine to help her become more comfortable treating patients with opioid use disorder. These resources and training culminated in Petersen successfully undergoing the mandatory 8 hours of training required by the Drug Enforcement Agency for the waiver to prescribe buprenorphine.

“I don’t feel afraid or intimidated by patients with opioid use disorder anymore,” Petersen said. “These resources taught me how to look for the patients who say they are always running out of opioid medications early, who say they are always going on vacation or say they’ve lost their prescription, since they are the ones who could be suffering from opioid use disorder.”

Darlene Petersen
Darlene Petersen

She added that support for physicians is also available even after the DEA waiver is received. Organizations such as the STR-TA (State Targeted Response-Technical Assistance) program create mentorships between physicians who just received the waiver and physicians who have had the waiver for several years, thus allowing any additional questions about treating patients with opioid use disorder to be answered.

Kurt Bravata, MD, a family physician in Buffalo, Missouri told Healio Family Medicine that there is a “clear need” for physicians to become competent in providing medication-assisted therapy and shared his professional path to doing so in his rural practice.

“I found Vivitrol (depo-naltrexone) to be an easy way to start offering these services as it did not require any additional certification. After 3 years of using naltrexone and Vivitrol in my family practice, I obtained my [DEA] waiver and started prescribing buprenorphine for qualifying patients,” he said.

Kurt Bravata
Kurt Bravata

Resources from the American Academy of Addiction Psychiatry (AAAP) and Substance Abuse and Mental Health Services Administration (SAMSHA) helped him overcome the barriers to care, while learning induction protocols and developing best practices, Bravata added.

Other resources

Besides the paths Petersen and Bravata took, the American Academy of Family Physicians also has several resources on its website for all family medicine clinicians who want to help patients with opioid addiction.

These include office-based tools to support patient care strategies, data and resources to help family medicine doctors work alongside community-based organizations, details on advocacy efforts taking place at the local state and national level and knowledge and education based on science instead of speculation.

“The AAFP recognizes the seriousness of the prescription drug abuse problem in the United States. As a medical organization, we must address the ongoing public health responsibility to provide adequate pain management,” the Academy’s website states.

AMA also offers resources on its website, such as links to articles from the JAMA Network that explore risk factors, causes and potential treatments to the opioid epidemic, CME offerings and information on safely storing and disposing opioids. – by Janel Miller

Disclosures: None of the authors report any relevant financial disclosures.

Just 10% of early career certified family physicians felt ready to provide buprenorphine treatment for opioid use, according to 2016 National Family Medicine Graduate Survey findings recently published in Annals of Family Medicine.

Many have called for increasing access to buprenorphine. A recent study, however, reported that only 28.6% of family medicine residencies have a required addiction medicine curriculum, and only 31.2% had at least one graduate obtain a waiver to prescribe buprenorphine in the past year,” Sebastian T. Tong, MPH, MD, of the department of family medicine and population health at Virginia Commonwealth University and colleagues wrote.

Researchers reviewed 1,979 responses from the 2016 National Family Medicine Graduate Survey to assess preparedness of the family physicians who completed their residency in 2013.

Tong and colleagues found 10% reported being adequately trained during residency to provide buprenorphine treatment and 7% reported providing buprenorphine treatment in their current practice. Of the latter group, 45.6% said this preparedness came as a result of their residency.

Being prepared

Darlene Petersen, MD, a family medicine practitioner in Utah who was not affiliated with the study, said she felt prepared to give buprenorphine treatment to patients with opioid use disorder early in her career.

She told Healio Family Medicine her turning point in recognizing the significance of having such a skill came during her first year of residency when she had a patient with chronic migraines and opioid use disorder that she was struggling to treat.

“At this point, my mentor sat me down and said, ‘You can either get the tools and training you need now, because you are going to have these patients throughout your career, or you can continue to be frustrated that you can’t help,’” she said.

While her mentor monitored how she handled patients, Petersen said she took online courses and reviewed tools available through the American Society of Addiction Medicine to help her become more comfortable treating patients with opioid use disorder. These resources and training culminated in Petersen successfully undergoing the mandatory 8 hours of training required by the Drug Enforcement Agency for the waiver to prescribe buprenorphine.

“I don’t feel afraid or intimidated by patients with opioid use disorder anymore,” Petersen said. “These resources taught me how to look for the patients who say they are always running out of opioid medications early, who say they are always going on vacation or say they’ve lost their prescription, since they are the ones who could be suffering from opioid use disorder.”

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Darlene Petersen
Darlene Petersen

She added that support for physicians is also available even after the DEA waiver is received. Organizations such as the STR-TA (State Targeted Response-Technical Assistance) program create mentorships between physicians who just received the waiver and physicians who have had the waiver for several years, thus allowing any additional questions about treating patients with opioid use disorder to be answered.

Kurt Bravata, MD, a family physician in Buffalo, Missouri told Healio Family Medicine that there is a “clear need” for physicians to become competent in providing medication-assisted therapy and shared his professional path to doing so in his rural practice.

“I found Vivitrol (depo-naltrexone) to be an easy way to start offering these services as it did not require any additional certification. After 3 years of using naltrexone and Vivitrol in my family practice, I obtained my [DEA] waiver and started prescribing buprenorphine for qualifying patients,” he said.

Kurt Bravata
Kurt Bravata

Resources from the American Academy of Addiction Psychiatry (AAAP) and Substance Abuse and Mental Health Services Administration (SAMSHA) helped him overcome the barriers to care, while learning induction protocols and developing best practices, Bravata added.

Other resources

Besides the paths Petersen and Bravata took, the American Academy of Family Physicians also has several resources on its website for all family medicine clinicians who want to help patients with opioid addiction.

These include office-based tools to support patient care strategies, data and resources to help family medicine doctors work alongside community-based organizations, details on advocacy efforts taking place at the local state and national level and knowledge and education based on science instead of speculation.

“The AAFP recognizes the seriousness of the prescription drug abuse problem in the United States. As a medical organization, we must address the ongoing public health responsibility to provide adequate pain management,” the Academy’s website states.

AMA also offers resources on its website, such as links to articles from the JAMA Network that explore risk factors, causes and potential treatments to the opioid epidemic, CME offerings and information on safely storing and disposing opioids. – by Janel Miller

Disclosures: None of the authors report any relevant financial disclosures.

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