Provider
For healthcare providers where buprenorphine programs are implemented, barriers and facilitators often relate to a lack of familiarity with or interest in providing opioid-related care in that particular clinical setting.
Barriers
Providers cite a limited understanding of buprenorphine for use in pain management. Prescribers may be unfamiliar with treatment guidelines and dosing strategies that impair optimal buprenorphine utilization for chronic pain.
Prior to 2022, providers were required to obtain a waiver to prescribe buprenorphine for OUD, but not for chronic pain. Since then, this waiver requirement has been eliminated, but much confusion remains with prescribers, believing that they are unable to prescribe buprenorphine under the current regulatory landscape.
Facilitators
There are several methods to disseminate evidence-based information to providers and care recipients on the safety and efficacy of buprenorphine for chronic pain management. One example is the University of Washington’s UW TelePain program, which offers video-based training services by pain medicine specialists to assist community-based practitioners’ uptake of best practices for prescribing and maintaining buprenorphine to treat chronic pain. The Department of Veterans’ Affairs (VA) also provides concise prescribing information for providers needing additional support in using buprenorphine for chronic pain. The Providers Clinical Support System can offer more specific guidance, such as how to manage breakthrough pain when a patient is already receiving long-term buprenorphine therapy.
Pharmacist integration into primary care teams is a model of care that allows for more shared decision-making and monitoring of individuals who require complex medication management. This may be especially useful during transition periods from other full agonist opioids to buprenorphine.