Barriers to Accessing Buprenorphine in the Primary Care Setting in the City of Detroit and Pertinent Policy Recommendations: A Consultancy Report for the Detroit Health Department

Abstract

Multiple barriers exist to prescribing and accessing medication-assisted therapy (MAT) for opioid use disorder; these disparities are even higher in cities like Detroit. In order to analyze the barriers to prescribing MAT in Detroit, particularly Buprenorphine/Naloxone, a semi-structured questionnaire was developed. From February to April 2019, 18 interviews were conducted amongst individuals identified as stakeholders in the epidemic. The three most commonly identified barriers to prescribing MAT, especially Buprenorphine/Naloxone, included lack of communication amongst stakeholders, insufficient clinical support for clinicians, and Medicaid insurance barriers. Recommended policy interventions include 1) facilitation of improved stakeholder engagement to increase awareness of MAT efficacy and ability to be integrated into primary care practice; 2) Creation of a platform to support primary care providers in offering MAT; 3) Engagement with policymakers on Medicaid insurance reform to improve the accessibility of MAT.