Friday, September 17, 2021

Residency Experience Treating Patients With Buprenorphine Boosts Prescribing Down the Road

The United States has a dearth of physicians who are trained to offer medication treatment with buprenorphine to patients with opioid use disorder (OUD). One community-based family medicine residency program in Massachusetts has shown that integrating patients treated with buprenorphine directly into resident training can help increase the number of graduates prescribing buprenorphine. Layla Cavitt, M.D., of the Tufts University School of Medicine Lawrence Family Medicine Residency and colleagues outlined the program’s steps and success in the Journal of Substance Abuse Treatment.

In 2011, the Lawrence residency program integrated mandatory Drug Enforcement Agency (DEA) X-waiver training into the second-year didactic curriculum. (The X-waiver is the special DEA license required by the Drug Addiction Treatment Act of 2000 that allows health care professionals to prescribe buprenorphine to outpatients for treatment of OUD.) Also, family medicine attending physicians began shadowing patients being treated for opioid use disorder in 2011. In 2014, the program integrated patients being treated with buprenorphine into resident continuity clinic patient panels, and residents managed two to five patients over the course of their residency, closely supervised by an attending physician experienced in buprenorphine treatment.

Cavitt and colleagues analyzed data from the 2016, 2017, 2018, and 2019 National Family Medicine Graduate Surveys, focusing on the respondents’ answers to questions about whether they believed that residency prepared them to prescribe buprenorphine and whether they currently prescribed buprenorphine.

Of those who responded to the national survey, more graduates of the Lawrence Family Medicine Residency reported they were adequately prepared to prescribe buprenorphine on graduation. For example, 75% of the graduating class of 2016 reported they were prepared to prescribe buprenorphine compared with 12% of respondents nationwide.

In addition, compared with respondents nationwide, more graduates of the Lawrence Family Medicine Residency reported prescribing buprenorphine in their practice three years after graduating. All of the graduating class of 2016 reported that they were prescribing buprenorphine three years after graduating compared with 12% of respondents nationwide.

“[Our residency] approach helps to build a rich repertoire of clinical skills invaluable to post-residency practice that go far beyond the skills acquired by simply obtaining a DEA-X waiver,” the researchers wrote. “We posit that our program has been successful because it produces physicians who treat opioid use disorder in practice, which is directly related to our program’s integration of patients receiving buprenorphine into residents’ continuity clinic panels. We recommend that this approach be considered an evidence-based approach to increasing the total number of graduates who go on to provide this life-saving medication in practice.”

For related information, see the Psychiatric News article “Resource Document Calls for Improved Residency Training on SUDs.”

(Image: iStock/Alernon77)

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