Buprenorphine Prescription in North Carolina

Abstract

A 2022 report from The Centers for Disease Control and Prevention (CDC) reported that 75% of overdose deaths involved the use of opioids. Medications such as Buprenorphine, Methadone, and Naltrexone can be used to treat opioid use disorder (OUD), and they are referred to as medication-assisted treatment (MAT). Buprenorphine acts as a partial opioid agonist, binding to opioid receptors in the brain and activating them less than a full agonist (e.g., heroin, oxycodone, fentanyl, morphine). This can decrease an individual's reliance on stronger opioids. Increasing the accessibility of Buprenorphine among individuals with OUD is essential to decreasing the prevalence of overdose-related deaths. In June 2023, the Mainstreaming Addiction Treatment Act decreased barriers and eliminated the x-waiver requirement for clinicians to prescribe Buprenorphine. The purpose of this study is to examine the prevalence of Buprenorphine prescription among clinicians in Pitt County, North Carolina, after the x-waiver was eliminated in June 2023. Due to the MAT act and x-waiver elimination, we hypothesize that the prevalence of Buprenorphine prescription will have increased since June 2023. Data was obtained through a convergent mixed methods Qualtrics survey. The survey design was largely based on the Consolidated Framework for Implementation Science (CFIR). Survey constructs included employment demographics, attitudes toward Buprenorphine prescription, Buprenorphine prescription prevalence, the impact of the x-waiver, infrastructure, barriers to prescribing Buprenorphine, and personal demographics. Clinicians were identified using the North Carolina Medical Board roster. Respondents consisted of Medical Doctors, Doctors of Osteopathic Medicine, and Physician Assistants, currently practicing in Pitt County. A recruitment letter outlining the study was sent to clinicians identified from the roster. The recruitment timeline was based on the Dillman Method, which assists with maximizing response rates. Data was analyzed using the SPSS statistics software. Descriptive statistics were applied to summarize the data both graphically and numerically. Qualitative data analysis was analyzed using a combination of deductive and inductive approaches. When assessing the impact of the x-waiver elimination on buprenorphine prescription prevalence, it was concluded that most participants (N = 23; 78.3% Medical Doctors, 65.2% white, 56.5% male) indicated no change in buprenorphine prescription since the x-waiver was eliminated in June 2023. When asked if their buprenorphine prescription habits had changed since June 2023, 13.0% were unsure if their prescription habits had changed, and 8.7% reported prescribing more buprenorphine. No clinicians stated they were prescribing less buprenorphine since the elimination of the x-waiver. Findings demonstrate that buprenorphine prescription habits did not change amongst the sample after the x-waiver was eliminated. A comprehensive approach combining education for clinicians and patients, addressing systemic gaps, and stigma influencing attitudes for MOUD treatment is needed to further improve buprenorphine prescription prevalence.