A team of researchers from the Center for Health Enhancement System Studies (CHESS) at the University of Wisconsin-Madison College of Engineering will test the ability of a bundle of practices to increase physician capacity to prescribe buprenorphine for opioid misuse disorders in addiction treatment organizations. Overdoses, largely due to prescription and non-prescription opioids, are now the leading cause of accidental death in the United States. Buprenorphine pharmacotherapy is a promising evidence-based practice for treating opioid dependence in the specialty addiction treatment centers that provide 88% of opioid addiction treatment care. However, only 17% of these centers provide buprenorphine pharmacotherapy; the leading cause for not using this therapy is the lack of certified physician prescribers. Traditional physician recruitment practices have not been effective in the addiction treatment field, leading to a shortage of physicians in the addiction treatment workforce. This study will test, to our knowledge for the first time, a physician recruitment intervention called te Physician Recruitment Bundle (PRB). This bundle of practices was developed and field- tested in a buprenorphine implementation trial of n=40 organizations and resulted in improvements in physician prescribing capacity of 43.4-100% within organizations. The PRB includes proven physician recruiting practices and relies on the evidence-based NIATx organizational change model to implement the bundle elements. An eligibility determination phase for this 4-state (FL, MS, OH, & WI) trial will identify 20 addiction treatment programs per state that need to increase buprenorphine prescribing capacity. This should not be difficult, since a recent representative survey of addiction treatment organizations indicated 33% sought more buprenorphine prescribing capacity. The project will have two arms: 1) PRB bundle implemented with the NIATx model; and 2) treatment as usual (control). Organizations will be segmented by state, with 20 organizations per state, 10 per arm, for a total of 80 organizations. The mixed methods design will measure the ability of the PRB framework to influence a) the number of buprenorphine prescribing slots available to the organization by recruiting more physicians; and 2) organizational factors known to be related to successful physician recruiting. The qualitative methods will complement the quantitative methods by understanding what factors impact physician recruitment and the context and processes used to influence PRB adoption. This trial addresses a structural barrier to buprenorphine therapy: lack of buprenorphine prescribing capacity. By increasing access to buprenorphine pharmacotherapy capable of reducing the morbidity and mortality of opioid addiction, this trial could have significant public health impact on the opioid misuse epidemic. Should the PRB be successful, it could be used to recruit physicians to medically underserved areas or other areas where physician shortages exist.

Public Health Relevance

Overdoses, due in a large part to the non-medical use of prescription opioids, have become the leading cause of accidental deaths in the United States. Yet, a leading evidence-based practice to treat opioid misuse disorders, buprenorphine pharmacotherapy, is underutilized in addiction treatment organizations due to the lack physicians certified to provide this pharmacotherapy, which only physicians can provide. This is part of a larger issue of physician workforce shortages in addiction treatment, and the proposed research will test the ability of the Physician Recruiting Bundle to increase buprenorphine prescribing capacity in addiction treatment organizations, resulting in more effective treatment for opioid misuse disorders.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Special Emphasis Panel (ZDA1)
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Duffy, Sarah Q
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University of Wisconsin Madison
Engineering (All Types)
Biomed Engr/Col Engr/Engr Sta
United States
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Molfenter, Todd; Sherbeck, Carol; Starr, Sandy et al. (2018) Payer Policy Behavior Towards Opioid Pharmacotherapy Treatment in Ohio. J Addict Med 12:85-91
Knudsen, Hannah K; Brown, Randy; Jacobson, Nora et al. (2018) Pharmacotherapy, Resource Needs, and Physician Recruitment Practices in Substance Use Disorder Treatment Programs. J Addict Med :
Molfenter, Todd; Knudsen, Hannah K; Brown, Randy et al. (2017) Test of a workforce development intervention to expand opioid use disorder treatment pharmacotherapy prescribers: protocol for a cluster randomized trial. Implement Sci 12:135