A mixed-method comparison of physician-reported beliefs about and barriers to treatment with medications for opioid use disorder

Subst Abuse Treat Prev Policy. 2020 Sep 14;15(1):69. doi: 10.1186/s13011-020-00312-3.


Background: Evidence demonstrates that medications for treating opioid use disorder (MOUD) -namely buprenorphine, methadone, and extended-release naltrexone-are effective at treating opioid use disorder (OUD) and reducing associated harms. However, MOUDs are heavily underutilized, largely due to the under-supply of providers trained and willing to prescribe the medications.

Methods: To understand comparative beliefs about MOUD and barriers to MOUD, we conducted a mixed-methods study that involved focus group interviews and an online survey disseminated to a random group of licensed U.S. physicians, which oversampled physicians with a preexisting waiver to prescribe buprenorphine. Focus group results were analyzed using thematic analysis. Survey results were analyzed using descriptive and inferential statistical methods.

Results: Study findings suggest that physicians have higher perceptions of efficacy for methadone and buprenorphine than for extended-release naltrexone, including for patients with co-occurring mental health disorders. Insurance obstacles, such as prior authorization requirements, were the most commonly cited barrier to prescribing buprenorphine and extended-release naltrexone. Regulatory barriers, such as the training required to obtain a federal waiver to prescribe buprenorphine, were not considered significant barriers by many physicians to prescribing buprenorphine and naltrexone in office-based settings. Nor did physicians perceive diversion to be a prominent barrier to prescribing buprenorphine. In focus groups, physicians identified financial, logistical, and workforce barriers-such as a lack of addiction treatment specialists-as additional barriers to prescribing medications to treat OUD.

Conclusions: Additional education is needed for physicians regarding the comparative efficacy of different OUD medications. Governmental policies should mandate full insurance coverage of and prohibit prior authorization requirements for OUD medications.

Keywords: Barriers; Buprenorphine; Comparison; Dual diagnosis; Methadone; Naltrexone; Physicians; Pregnant; Referral; Survey.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Analgesics, Opioid / therapeutic use
  • Attitude of Health Personnel*
  • Buprenorphine / therapeutic use
  • Delayed-Action Preparations
  • Drug and Narcotic Control / legislation & jurisprudence
  • Female
  • Humans
  • Insurance Coverage / organization & administration
  • Insurance, Health / organization & administration
  • Male
  • Mental Disorders / epidemiology
  • Methadone / therapeutic use
  • Naltrexone / therapeutic use
  • Narcotic Antagonists / therapeutic use
  • Opiate Substitution Treatment / methods*
  • Opioid-Related Disorders / drug therapy*
  • Opioid-Related Disorders / epidemiology
  • Practice Patterns, Physicians'
  • Specialization
  • United States / epidemiology


  • Analgesics, Opioid
  • Delayed-Action Preparations
  • Narcotic Antagonists
  • Buprenorphine
  • Naltrexone
  • Methadone