SCIENTIFIC
Prescriber Attitudes and Medication Assisted Treatment
AUTHORS : Courtney A . Hereford , MSPH , MSW 1
Jacob Lyon , MD 2 Norman Montalto , DO 3 James Becker , MD 4 Todd H . Davies , PhD 2
1
WVSOM Center for Rural and Community Health
2
Department of Family and Community Health , Marshall University Joan C Edwards School of Medicine
3
Former CMO of West Virginia Family Health MCO
4
West Virginia Bureau for Medical Services
INTRODUCTION
In 2017 , an estimated 72,000 lives were lost in the United States ( US ) from drug overdose , 1 and the number continues to climb steadily . Millions of Americans continue to suffer with substance use disorder ( SUD ), including opioid use disorder ( OUD ). The National Center for Drug Abuse Statistics estimates that in 2018 , 8.1 million Americans had been diagnosed with SUD and 2 million had been diagnosed with OUD . 2 The net effect is a $ 34.6 billion federal budget for drug control . 2 In one of the most profound public health crises our nation has faced , West Virginia ( WV ) is at the forefront of the opioid epidemic .
Overprescribing and misuse of opioids can lead to addiction , overdose , and death . In order to address this multifaceted problem , both national and state agencies have provided guidelines and legislation to support enhanced prescribing and treatment practices . 3 WV had the highest rate of mortality by drug overdose in the US in 2018 ( 51.5 / 100,000 ), nearly tripling the national rate ( 21.7 ) and surpassing second ranked Delaware by 15 %. 1 Rates of overdose deaths more than doubled between 2010 and 2017 , with 1,065 West Virginians losing their lives
ABSTRACT
INTRODUCTION Increases in opioid use disorder ( OUD ) and the consequences to communities across the United States have resulted in a call for an increase in buprenorphine-based medicationassisted treatment ( MAT ) options . As legislative efforts continue to expand , it is important to understand the provider viewpoint of any such expansion .
METHODS An anonymous survey was conducted in 2019 among primary care physicians , specialists , and mid-level practitioners , as well as dentists , optometrists , veterinarians , and providers currently practicing in West Virginia ( WV ) and eligible to prescribe opioids and scheduled substances . The survey included both quantitative and qualitative items measuring provider self-reported practices , training , support , experiences , and perceptions on treatment of patients using MAT .
2019 alone . 4 This epidemic bears a substantial financial burden on the state , with expenses related to fatalities , healthcare , SUD treatment , criminal justice , and lost productivity costing WV more than $ 8.72 billion in 2016 . 5
In 2014 , an estimated 91 % of eligible West Virginians and 89 % of eligible individuals , nationally , were not receiving SUD treatment . 5 Only 10 % of individuals who had non-fatal opioid overdoses in WV received treatment , including buprenorphine and medications for OUD , follow-up , and mental health counseling . Additionally , only 7.3 % of those who overdosed were found to be taking buprenorphine at 12-month follow-up . 6 When assessing such statistics , it is worth considering the unique population , context and barriers encountered within the state . Challenges with health behaviors , healthcare access and delivery , and significant socioeconomic disparities
RESULTS A significant ( p < 0.001 ) majority of providers reported the need for MAT expansion and the belief that patients with OUD benefit from MAT ( 2.7 % response rate ). Despite this acknowledged need and established efficacy of MAT , survey findings suggest that fewer providers in WV seem interested or willing to expand their practice by providing MAT without additional resources and support .
DISCUSSION Despite a small response rate , the participants ’ responses provide useful information . While recent legislation efforts to encourage expansion of treatment waivers and access have been successful , providers reported significant barriers to expanding or incorporating MAT into their practices . Current MAT practitioners report institutional and staff support as major factors in their willingness to provide MAT . The critical question remains on how best to incentivize and sustain MAT practice and remove barriers for providers to meet the growing need and improve care .
associated with rural areas are compounded in Appalachian regions like WV due to the isolated terrain within resource-limited settings . Addressing the dramatic shortage of rural providers and clinics , and particular deficits of behavioral health and specialty care , poses additional considerations in developing effective systems of care . 7-9
WV and other states have responded with legislative efforts aimed to promote appropriate prescribing , expand access to addiction treatment and harm reduction services , elicit more aggressive response to overdose , penalize traffickers , engage in civil litigation and disciplinary action , and raise awareness and educate the public . A number of state policies have been passed to address the critical issues associated with the epidemic :
• In 2014 , WV Medicaid expansion increased the number of people able to
30 • www . wvsma . org