Perceptions and practices addressing diversion among US buprenorphine prescribers

•Examined prescriber perceptions and practices addressing buprenorphine diversion.•A third of prescribers say diversion is a significant concern in their communities.•Majority of prescribers report assessing all patients for buprenorphine diversion.•Assessment and response to diversion differed base...

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Bibliographic Details
Published in:	Drug and alcohol dependence 2018-05, Vol.186, p.147-153
Main Authors:	Lin, Lewei (Allison), Lofwall, Michelle R., Walsh, Sharon L., Gordon, Adam J., Knudsen, Hannah K.
Format:	Article
Language:	eng
Subjects:	Addictions Adult Buprenorphine Bypasses Characteristics Communities Diversion Drug diversion Drug Prescriptions - statistics & numerical data Drug therapy Drugs Experts Female Health Knowledge, Attitudes, Practice Health Personnel - education Health Personnel - statistics & numerical data Humans Male Middle Aged Narcotic Antagonists Narcotics Opioid use disorder Opioid-Related Disorders - drug therapy Opioids Patients Perceptions Prescribing Prescription Drug Diversion Providers Psychiatry Risk assessment Sampling methods Substance abuse treatment Treatment United States Urine Urine tests
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Summary:	•Examined prescriber perceptions and practices addressing buprenorphine diversion.•A third of prescribers say diversion is a significant concern in their communities.•Majority of prescribers report assessing all patients for buprenorphine diversion.•Assessment and response to diversion differed based on prescriber characteristics. While there has been a dramatic increase in prescribing of buprenorphine for the treatment of opioid use disorder in the US, little is known about prescribers’ attitudes and practices regarding buprenorphine diversion and how they relate to prescriber characteristics. A national random sample of buprenorphine prescribers (N = 1174) completed surveys from July 2014 to January 2017. Analyses examined relationships between prescriber and practice characteristics and prescriber perceptions and approaches regarding diversion. Among this sample of buprenorphine prescribers, 79.0% (N = 898) reported assessing all patients for risk of buprenorphine diversion and misuse. A third of prescribers described diversion as a significant or very significant concern in their community. The majority of prescribers reported seeing patients on average at least every other week during the first 60 days of treatment, and the majority reported testing urine for buprenorphine to assess for diversion. Perceptions of diversion being a greater problem in their community (AOR 1.212, 95% CI 1.073–1.369) and use of medication counts (AOR 1.006, 95% CI 1.003–1.009) were associated with increased likelihood of terminating patients when diversion was suspected, while having expertise in addiction (AOR 0.526, 95% CI 0.406–0.682) or psychiatry (AOR 0.714, 95% CI 0.558–0.914) were associated with decreased odds of terminating treatment for suspected diversion. Buprenorphine prescribers report diversion is an important issue, and most prescribers report that they assess patients for diversion, though specific practices differ based on prescriber and practice characteristics.
ISSN:	0376-8716 1879-0046