Appropriateness is defined as the perceived fit or compatibility of a given intervention to address a particular issue. The appropriateness of buprenorphine as an alternative to other opioids for long-term opioid therapy to treat chronic pain has been evaluated using a survey administered to primary care providers in the VHA setting. Results indicated that primary care providers with a history of buprenorphine prescribing believe that buprenorphine is an effective alternative to long-term opioid therapy at a higher rate compared to primary care providers with no history of buprenorphine prescribing. This finding suggests that familiarity and comfort with buprenorphine prescribing directly correlate with beliefs about treatment appropriateness. Thereby, efforts to increase prescriber training can bolster implementation by fostering greater confidence in the appropriateness of treatments for chronic pain.

Acceptability refers to the degree to which a partner believes the intervention is palatable, agreeable, or satisfactory for a given issue. In the context of buprenorphine for chronic pain, acceptability has been measured through semi-structured interviews of individuals who had switched from other opioids to buprenorphine to manage their pain. Care recipient perspectives demonstrated a high degree of acceptability for buprenorphine, primarily driven by increased functionality, quality of life, and improved pain.

Fidelity refers to the degree to which an intervention is followed as designed. Penetration refers to the degree to which the intervention is adopted among a population. In a recent randomized trial, some participants were assigned to a buprenorphine option arm wherein their primary care provider was to discuss the option to switch to buprenorphine from their current high-dose opioid regimen. It was observed that less than 80% of this cohort had a discussion with their provider about switching to buprenorphine, indicating a low fidelity to the intended buprenorphine switching protocol. There was also a low rate of those switching to buprenorphine, indicating low penetration among clients who were identified as appropriate candidates to transition to buprenorphine. This study again highlights the current lack of provider comfort with offering buprenorphine, even when identified as appropriate, precipitating low penetration rates of buprenorphine uptake.