Barriers to Buprenorphine Prescribing for Opioid Use Disorder Among Louisiana Family Physicians: A Pilot Survey Study With Narrative Review

TL;DR

This study explores why many Louisiana family doctors don't prescribe buprenorphine for opioid addiction, finding that time, education, and support are key issues.

Contribution

The study identifies specific practical barriers to buprenorphine use in family medicine and suggests targeted interventions for improvement.

Findings

Most physicians (74%) did not prescribe buprenorphine due to concerns like time and lack of specialist access.

Top barriers included fear of disruptive patients and insufficient training in opioid use disorder management.

Regulatory and safety concerns were less frequently cited than practical and educational barriers.

Abstract

Background

Opioid use disorder is a prevalent and complex condition encountered in primary care. Buprenorphine is widely recognized as an effective pharmacologic treatment, yet it is not routinely incorporated into family medicine practices. This study aimed to assess perceived barriers to buprenorphine prescribing among Louisiana family physicians and to contextualize these barriers through a narrative review focused on practical implementation strategies.

Methods

This pilot, cross-sectional survey study was conducted among practicing family physicians in Louisiana and approved by the Louisiana State University Health Sciences Center-Shreveport Institutional Review Board (IRB). The anonymous, electronic survey was distributed to non-resident members of the Louisiana Academy of Family Physicians (LAFP) in September 2023 using a web-based platform. The survey assessed current buprenorphine prescribing practices and perceived barriers among non-prescribing respondents. Descriptive statistics were used to summarize results.

Results

A total of 65 family physicians completed the survey. Seventeen respondents (26%) reported actively prescribing buprenorphine for opioid use disorder, while 48 (74%) did not. Barrier-related items were completed only by non-prescribers (n = 48). The most frequently reported barriers included concern about attracting disruptive patients (54%), insufficient time to initiate and manage treatment (50%), lack of access to substance use disorder specialists (50%), insufficient education or training in opioid use disorder management (48%), concerns about diversion or misuse (37.5%), and limited availability of mental health services (37.5%). Regulatory concerns, including fear of Drug Enforcement Administration (DEA) intrusion, were reported by 27% of respondents, while fewer expressed concerns regarding safety, effectiveness, reimbursement, or practice partner resistance.

Conclusions

In this pilot survey of Louisiana family physicians, most respondents did not prescribe buprenorphine despite recognizing the ongoing need for opioid use disorder treatment in their communities. Barriers to prescribing were multifactorial and primarily related to time constraints, educational gaps, perceived clinic disruption, and limited support resources rather than doubts about medication safety or efficacy. These findings highlight opportunities for targeted educational, structural, and workflow-focused interventions to expand medication for opioid use disorder (MOUD) delivery in family medicine and improve access to evidence-based opioid use disorder treatment.

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