The need for outpatient management of opioid use disorder with medication-assisted treatment has continued to rise yet physician comfort with prescribing buprenorphine remains low. A survey assessing comfort prescribing was disseminated to attending physicians in the Division of General Internal Medicine at an academic medical center followed by semi-structured qualitative interviews. The majority of respondents (71%) reported that they had not prescribed buprenorphine in an outpatient setting despite being trained and 67% stated that they felt "uncomfortable" or "very uncomfortable" doing so. However, almost all survey respondents (89%) reported comfort precepting residents prescribing buprenorphine. Attending physicians attribute this differential comfort to structural forces including a lack of team-based care, time, and psychosocial support services in their own practice as compared to the academic residency clinic. These findings highlight the barriers to prescribing buprenorphine and challenge the existing notion that academic centers are not suitable places for substance use treatment.
Keywords: academic medical center; academic residency clinic; buprenorphine; prescribing; substance use disorder.