Table 1.
Summary of results comparing psychiatrists who did and did not complete any buprenorphine course during residency.
| Completed buprenorphine training (n=52) | Did not complete buprenorphine training (n=41) | P | |
|---|---|---|---|
| Age | 35.0 (SD 3.9) | 34.8 (SD 4.7) | NS |
| Gender | M: 26 (50.0%) F: 26 (50.0%) |
M: 11 (26.8%) F: 30 (73.2%) |
χ2=5.24, p=0.022 |
| Ethnicity | W: 31 (59.6%) B: 3 (5.8%) H: 6 (11.5%) A: 12 (23.1%) |
W: 32 (78.1%) B: 0 (0%) H: 2 (4.9%) A: 7 (17.1%) |
NS |
| Year completed psychiatry residency | |||
| 2008 | 0 | 1 (2.4%) | NS |
| 2009 | 9 (17.3%) | 9 (22.0%) | NS |
| 2010 | 14 (26.9%) | 12 (29.3%) | NS |
| 2011 | 29 (55.8%) | 19 (46.3%) | NS |
| Practice setting | |||
| Solo practice | 6 (11.5%) | 1 (2.4%) | NS |
| Single specialty group | 2 (3.9%) | 4 (9.8%) | NS |
| Hospital-owned practice | 20 (38.5%) | 13 (31.7%) | NS |
| Solo practice shared space | 3 (5.8%) | 3 (7.3%) | NS |
| Multidisciplinary practice | 8 (15.4%) | 3 (7.3%) | NS |
| Staff model HMO | 0 | 1 (2.4%) | NS |
| Sub-specialty fellowship training | 10 (19.2%) | 6 (14.6%) | NS |
| Research fellowship training | 1 (1.9%) | 1 (2.4%) | NS |
| Research | 1 (1.9%) | 2 (4.9%) | NS |
| Other | 11 (21.2%) | 12 (29.3%) | NS |
| Estimated proportion of patients currently in treatment with heroin dependence (%) | 7.5 (SD 19.5) | 14.3 (SD 20.7) | NS |
| Estimated proportion of patients currently in treatment with prescription opioid dependence (%) | 8.9 (SD 10.4) | 14.9 (SD 19.5) | NS |
| Buprenorphine course taken (some residents took more than one course) | H&H course: 22 (33.3%) On-line course: 13 (25.5%) 8-hour course: 21 (40.3%) |
None | N/A |
| Prescribed buprenorphine in residency under supervision | 13 (25.0%) | 0 | N/A |
| Currently prescribing | 20 (38.5%) | N/A | N/A |
| Listed on SAMHSA site | 13 (25.0%) | N/A | N/A |
| Attitudes (number of respondents reporting either “strongly agree” or “agree”) | |||
| I am confident in my ability to treat opioid addiction | 44 (84.6%) | 19 (46.3%) | χ2=9.57, p<0.001 |
| I had no intention of prescribing buprenorphine before the training | 16 (30.8%) | N/A | N/A |
| My residency training prepared me adequately to treat patients with opioid addiction | 30 (57.7%) | 19 (46.3%) | NS |
| Opioid addiction is a treatable illness | 51 (98.1%) | 31 (75.6%) | Fisher's, p<0.05 |
| Buprenorphine maintenance is an effective treatment for opioid addiction | 51 (98.1%) | 31 (75.6%) | Fisher's, p<0.05 |
| Buprenorphine diversion is a significant problem | 33 (63.5%) | 25 (61.0%) | NS |
| Patients on buprenorphine maintenance are not really in recovery | 4 (7.7%) | 4 (9.8%) | NS |
| Detoxification should be attempted before maintenance treatment | 17 (32.7%) | 21 (51.2%) | χ2=4.81, p<0.05 |
| Buprenorphine training should be offered to all psychiatry residents | 52 (100.0%) | 33 (80.5%) | Fisher's, p<0.05 |
| The buprenorphine training made me more confident about treating opioid addiction | 49 (94.2%) | N/A | N/A |
| Barriers to prescribing | |||
| Lack of training in treating opioid addiction | 8 (15.4%) | 15 (36.5%) | χ2=5.54, p=0.019 |
| No supervision from experienced mentors | 14 (26.9%) | 14 (34.2%) | NS |
| Do not believe the effectiveness of buprenorphine | 1 (1.9%) | 3 (7.3%) | NS |
| Worried about patients overdosing on buprenorphine | 0 | 2 (4.9%) | NS |
| Do not want to attract patients with opioid addiction to my office | 8 (15.4%) | 14 (34.2%) | χ2=4.46, p=0.035 |
| Worried about patients becoming addicted to buprenorphine | 3 (5.8%) | 3 (7.3%) | NS |
| Patient demand for buprenorphine too low | 1 (1.9%) | 7 (17.1%) | χ2=7.18, p=0.007 |
| Concerns about patients diverting buprenorphine | 8 (15.4%) | 15 (36.6%) | χ2=5.54, p=0.019 |
| Concerns about DEA visits | 4 (7.7%) | 2 (4.9%) | NS |
| Lack of counseling support | 16 (30.8%) | 10 (24.4%) | NS |
| Logistical problems of setting up buprenorphine practice | 26 (50.0%) | 21 (51.2%) | NS |
| Lack of organizational and institutional support | 16 (30.8%) | 13 (31.7%) | NS |
| High cost of providing buprenorphine | 2 (3.9%) | 4 (9.8%) | NS |
| Difficulty with reimbursement | 4 (7.7%) | 3 (7.3%) | NS |