need and value of opioid treatment for their patients as well as ancillary social and community recovery resources . Many respondents also indicated that the state legislature and state policies have created an “ unwelcome regulatory burden ” on medical care for providers and patients . “ Onerous and punitive legislative requirements ” as well as the “ risk of liability ” were cited as deterrents for physicians to engage in opioid-related treatment for pain and MAT . Several providers expressed the critical need for an effective , impartial compliance monitoring system that penalizes individual providers in place of more comprehensive government restrictions and regulations imposed upon all . Others reported financial barriers such as high-cost insurance coverage for alternative treatment options , expensive co-pays , and uncovered services . In addition , some respondents reported that non-pharmacologic alternatives for care were not available in or near their practice location . Additional providers reported that their practices already met or exceeded capacity with patient care and reiterated a significant need for more local treatment and recovery resources .
As such , the research team reviewed and coded all responses to this final question into two dominant themes : promoters / incentives and barriers , the latter of which was broken down into subthemes of logistical , legislative , and stigma barriers . Sample responses illustrating those themes are depicted below :
Promoters / Incentives
• “ Treating people for opioid issues is the first step in helping them become a productive and integrated member of society . Social support for recovery and finding jobs is important to prevent relapse .”
• “ I would like to be able to start willing patients on MAT , if there were resources once they get discharged , to continue mental health and medication support .”
• “ No question that MAT is effective in treatment of OUD . Might require a lifetime of treatment like other chronic diseases . Must be coupled with other support services , including counselors , social workers , housing , and job support .”
BARRIERS Logistical Barriers
• “ Local physicians are overwhelmed already by patient care . Adding MAT to an already overwhelmed practice is not going to be effective . Help !”
• “ MAT isn ' t available where I live . Patients have to drive 60 miles and many of the probation officers and judges don ' t allow it . This creates a cycle of use and incarceration and poverty .”
• “ Insurance coverage of alternative treatments need cheaper options for patients .”
Legislative Barriers
• “ I have no intentions of ever prescribing opioids due to the extreme risk of liability .”
• “ A high-quality compliance monitoring program that only deals if fact and not emotion could greatly benefit both patient and physicians especially in light of the rural nature of our state . Making [ treatment decisions ] based on black and white metrics is a great way to help local providers prescribe with less anxiety and lessen the need for more chronic pain clinics .”
• “ The OFLAC rules put providers on the defensive and are unnecessarily restrictive .”
Stigma Barriers
• “ The stigma surrounding MAT makes it difficult to get unbiased assistance from psychiatrists and pharmacists .”
• “ It was in that WV community that I watched an entire generation be lost to opioid addiction . I watched suboxone be used as a major IV and abused drug . Giving people more numbing agents does nothing to improve their motivation to not be addicted .”
• “ Strongly disagree with MAT . MAT is only politically correct continued substance abuse . Abstinence is the only appropriate treatment for addiction .”
DISCUSSION
A significant ( p < 0.001 ) majority of providers reported a need for additional MAT in their area and believed that patients with OUD would benefit from MAT . Despite this acknowledged need and the demonstrated effectiveness of MAT , survey findings suggest that many providers are still resistant to providing MAT . Few respondents directly disagreed with MAT as a treatment strategy for OUD altogether . In aggregate , providers noted significant barriers to expanding and / or incorporating MAT into their practice . Despite the generally positive legislative reforms passed prior to this study , the foremost barriers cited by both primary care and specialty care physicians were legislative , regulatory , and administrative burdens and obstacles . One prescriber best summed up the overall respondent attitude commenting , “ There should be more providers for MAT , but I don ' t want to be one of them .” This statement was one of the least agreed upon points between all prescribers and those who currently provide MAT , and some providers are simply not likely to provide MAT services regardless of support . Efforts across WV by multiple agencies , including the state ’ s three medical schools and the relatively new Office of Drug Control Policy have been effective in increasing the number of MAT providers and patients prescribed buprenorphine for OUD . Nevertheless , the 2019 decrease in number of patients per MAT provider suggests a potential saturation point or efficiency threshold ( Figure 3 ). There continues to be a state and national focus on expanding MAT access and availability , as more capacity is believed to be needed to meet the ever-growing OUD epidemic . However , our findings suggest that many providers are still resistant to providing or expanding this service in their practice , which may correlate with the roughly 30 % of approved providers who are not actively prescribing buprenorphine and the recent decrease in patient / prescriber ratio .
Expanding MAT training and education opportunities has successfully increased
West Virginia Medical Journal • September 2022 • 35