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Buprenorphine induction: a major barrier for physician adoption of office-based opioid dependence treatment.

To the Editor: Albright et al. (2010) should be congratulated for their multistate physician survey study examining barriers for buprenorphine treatment adoption, which adds to a growing body of literature on various system-level and provider-level factors limiting integration of buprenorphine treatment in practice (Gunderson et al., 2006; Kissin et al., 2006; Cunningham et al., 2007; Walley et al., 2008; Barry et al., 2009; Netherland et al., 2009). Given the effectiveness of office-based opioid treatment (OBOT) yet persistent national gap in treatment availability, studies such as theirs are needed to help elucidate potential targets to facilitate implementation in clinical practice. Eleven potential barriers were identified during survey development. However, a major one was omitted: the challenge of buprenorphine induction. Several survey studies indicate that the induction challenge limits physician adoption of buprenorphine treatment in clinical practice (Gunderson et al., 2006; Kissin et al., 2006; Walley et al., 2008; Netherland et al., 2009). Induction appears to pose a greater challenge for inexperienced buprenorphine providers (Netherland et al., 2009), including buprenorphinecertified addiction specialists early after buprenorphine became available in the United States (Kissin et al., 2006), and psychiatrists and generalists after completion of a Center for Substance Abuse Treatment-sponsored online and faceto-face buprenorphine training course (Gunderson et al., 2006). The induction challenge is highlighted perhaps most prominently by the volume of inquiries to the Physician Clinical Sup-