Exploring Diversion Concerns as a Modifiable Buprenorphine-prescribing Barrier Among Primary Care Professionals

Efforts to increase medications for opioid use disorder (MOUD) prescribing among primary care professionals (PCPs) are a priority for reducing overdose and related harms. A primary concern among PCPs, however, is that prescriptions will be diverted or sold to someone else. Understanding and contextualizing diversion concerns among PCPs can inform implementation strategies to support buprenorphine adoption and expand access to medication.

We conducted semistructured interviews with Ohio PCPs as part of the design and pilot of a training intervention to increase PCP buprenorphine prescribing. Interviews were transcribed and analyzed using three-step thematic analysis in Dedoose. Detailed memos on all codes were written and inductively informed key themes pertaining to addressing PCPs' diversion concerns.

Twenty-six PCPs completed in-depth interviews. Diversion concerns were common and limited willingness to prescribe buprenorphine or changed the way PCPs prescribed. Three key themes emerged: (1) Diverse diversion concerns continue to influence prescribing behavior; (2) Prescribing experience and comfort with harm reduction shaped views on diversion; and (3) Specific forms of diversion information can motivate buprenorphine prescribing.

Buprenorphine is highly effective for reducing mortality in patients with opioid use disorder, but it is vastly underutilized in the primary care setting. Diversion concerns among both nonprescribers and current prescribers are a significant barrier to expanding access in this setting. Leveraging data and personal anecdotes on the scope of, public health impact of, and reasons for diversion may help overcome this commonly cited barrier to prescribing MOUD.