Buprenorphine unobserved "home" induction: a survey of Ontario's addiction physicians

BackgroundOntario patients on opioid agonist treatment (OAT) are often prescribed methadone instead of buprenorphine, despite the latter's superior safety profile. Ontario OAT providers were surveyed to better understand their attitudes towards buprenorphine and potential barriers to its use, including the induction process.MethodsWe used a convenience sample from an annual provincial conference to which Ontario physicians who are involved with OAT are invited.ResultsBased on 85 survey respondents (out of 215 attendees), only 4% of Ontario addiction physicians involved in OAT routinely used unobserved home buprenorphine induction: 59% of physicians felt that unobserved induction was risky because it was against the guidelines and 66% and 61% respectively believed that unobserved home induction increased the risk of diversion and of precipitated withdrawal.ConclusionsOntario addiction physicians largely report following the traditional method of bringing in patients for observed in-office buprenorphine induction: they expressed fear of precipitated withdrawal, diversion, and going against clinical guidelines. The hesitance in using unobserved induction may explain, in part, Ontario's reliance on methadone.