Table 1.

Summary of Provider Perceptions of System-Level Opioid Prescribing and Addiction Treatment Policies.

	Findings	Evidence
Opioid Prescribing Guidelines
General Guidelines	• Often local (practice-based) guidelines superseded government guidelines	• Kilaru et al., 2014
Dosage	• Physicians were more aware than other prescribers of state guidelines • Most physicians (67%) were aware of CDC Guidelines • Awareness of guidelines was associated with confidence in prescribing • Providers with higher number of CME hours had higher knowledge and utilization of CDC guidelines	• Franklin, 2013 • Ebbert, 2017 • McCalmont et al., 2018
Risk Mitigation	• Majority of surveyed prescribers were unaware of REMS guidelines • 50% of physicians surveyed were unwilling to perform mandatory education requirements for REMS • Primary care physicians only partially compliant with American Pain Association Guidelines	• Salinas, Robinson & Abdolrasulnia, 2012 • Slevin & Ashburn, 2011 • Khalid et al., 2015
Intervention-focused	• Only 27.7% of surveyed primary care physicians knew of SBIRT • Prescribers had mixed feelings on elements of SBIRT: some found urine screening useful and identifying high risk patients, others felt urine screening did not facilitate trust with patients	• Harris & Yu, 2016 • Barry et al., 2010; Krebs et al., 2014
Prescription Drug Monitoring Programs
PDMPs	• Awareness of PDMPs across medical specialties is high, between 70–90% • Prescribers did not register for PDMP largely because of registration difficulties • States with PDMP use mandates experienced higher prescribers registration • Prescribers who use PDMP report increased awareness of prescribing behaviors and prescribe fewer and smaller doses of opioids	• Blum, Nelson & Hoffman, 2016; Kohlbeck et al., 2018; Hwang et al., 2016; Irvine et al., 2014; Perrone, DeRoos & Nelson, 2012; Rutkow et al., 2015 • Blum, Nelson & Hoffman, 2016; Feldman et al., 2011; Fleming et al., 2014; Kohlbeck et al., 2018; Perrone, DeRoos & Nelson, 2012 • Williams et al., 2018 • Lin et al., 2017; Martello et al., 2018; McAllister et al., 2015; Pomerleau, Schrager & Morgan, 2016
Medications for Opioid Addiction Treatment
Buprenorphine	• Majority of providers support buprenorphine as an effective medication to treat OUD, but only 25% felt confident they could actually prescribe buprenorphine • Federal regulations (buprenorphine cap and waiver) as well as prior authorization requirements proved quite cumbersome for providers in prescribing buprenorphine	• DeFlavio et al., 2015 • Andraka-Christou & Capone, 2018; DeFlavio et al., 2015; Hutchinson et al., 2014; Kermack et al., 2017
Naltrexone	• Little is known about prescriber opinions of naltrexone as it is a fairly new drug • Barriers regarding insurer reimbursement policies (prior authorization, fail-first therapies) are a concern	• Andraka-Christou & Capone, 2018
Naloxone Access and Distribution Programs
Naloxone	• Providers had overwhelming support for naloxone distribution programs at the clinical level • Gaps in knowledge about how to effectively prescribe naloxone and identify patients in need explain the few providers who participate in naloxone distribution	• Behar et al., 2018; Okoro et al., 2018; Peckham et al., 2018; Wilson et al., 2016 • Behar et al., 2018; Wilson et al., 2016