Buprenorphine Prescribing Among Primary Care Clinicians for Chronic Pain and Opioid Use Disorder.

Abstract

Buprenorphine is a partial µ-opioid agonist approved by the Food and Drug Administration (FDA) for the treatment of chronic pain and opioid use disorder (OUD). Despite its favorable safety profile compared with other opioids and the 2022 US Department of Veterans Affairs and Department of Defense guideline recommending it as first-line opioid for patients with chronic pain requiring daily opioids, its adoption among primary care clinicians (PCCs) remains limited. This survey aims to evaluate PCCs' familiarity with and interest in prescribing and/or transitioning patients to buprenorphine for chronic pain and OUD. In addition, we assessed their interest in using an electronic Consult (eConsult) platform to support buprenorphine prescribing. An anonymized electronic survey was distributed to our institution's PCCs working across 53 clinics in rural southern Minnesota and western Wisconsin. Our survey was deployed for 2 weeks. We received 146 responses (31.7% response rate). Only 37% of respondents currently prescribe buprenorphine, and 19% prescribed it for both OUD and chronic pain. Despite this, 72% expressed interest in prescribing buprenorphine in the future. Key barriers to prescribing included insufficient knowledge (76%) and lack of confidence (78%). Additional concerns included cost, insurance challenges, stigma, patient resistance, and inadequate training. Notably, 89% of respondents expressed interest in using an eConsult platform for buprenorphine initiation and transition. These findings suggest a need for enhanced education, resource access, and institutional support to help PCCs incorporate buprenorphine into their practices, potentially improving the management of chronic pain and OUD.