French general practitioners' attitudes and prescription patterns toward buprenorphine maintenance treatment: does doctor shopping reflect buprenorphine misuse?

J Addict Dis. 2005;24(3):7-22. doi: 10.1300/J069v24n03_02.

Abstract

This study investigated attitudes toward buprenorphine maintenance treatment (BMT) among general practitioners (GPs) and their maintained patients' propensity to turn to several prescribers (doctor shopping), among a sample of 345 GPs prescribing BMT in South-Eastern France. Survey data were anonymously matched to administrative data that provided information about GPs' patients. A simultaneous equation model suggests that GPs' attitude influenced doctor shopping, not the reverse. Doctor shopping was lower among GPs who reported inducting BMT with 8 mg of buprenorphine per day or more, and was higher for GPs endorsing a stringent attitude toward patients. Thus doctor shopping should not be understood exclusively as a deviant behaviour. It is partially physician-driven, and further research is needed to assess whether it reflects patients' dissatisfaction toward inappropriate care supply and the difficulty to establish a good therapeutic relationship between an opiate-dependent patient and a general practitioner.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Buprenorphine* / therapeutic use
  • Cluster Analysis
  • Cross-Sectional Studies
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • France
  • Humans
  • Long-Term Care / statistics & numerical data
  • Male
  • Middle Aged
  • Models, Statistical
  • Narcotic Antagonists* / therapeutic use
  • Physician-Patient Relations
  • Physicians, Family / psychology*
  • Physicians, Family / statistics & numerical data
  • Referral and Consultation / statistics & numerical data*
  • Risk Assessment / statistics & numerical data
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / epidemiology*
  • Substance-Related Disorders / psychology

Substances

  • Narcotic Antagonists
  • Buprenorphine