top of page
Search

“I Don’t Have Those Patients”: A Closer Look at Provider Hesitation and Expanding Access to Buprenorphine Treatment

By: Jamelia Hand MHS CADC CODP I



Over the years, i’ve had the opportunity to help more than 70 healthcare organizations. From Federally Qualified Health Centers to group practices, from OB-GYN clinics and student health centers to jails and reentry programs, i’ve launched or expanded office-based opioid treatment (OBOT). These efforts have been deeply rewarding, but they always start with the same conversation: a provider who cares deeply about their patients, but has honest concerns about treating opioid use disorder (OUD).


As someone who isn’t a physician but has spent the last two decades supporting those who are, i’ve learned to listen carefully. The reasons for hesitation are real, not excuses. They usually come from a desire to do no harm, to protect professional integrity, and to deliver safe, effective care. But for every delay, there’s a patient whose window for treatment is closing.


The good news? These barriers are not insurmountable. In fact, most can be addressed with information, structure, and support. It’s essential to approach these concerns with empathy and understanding, recognizing that providers operate within intricate systems and face numerous pressures. By examining common hesitations and the real-world implications for patients, we can cultivate a more supportive environment that encourages providers to engage in life-saving OUD treatment.


So what are some of the common provider concerns and their impact on patient care?


“I Don’t Have Those Patients in my Practice”


This is one of the most common beliefs, and one of the most dangerous. Many providers assume OUD is something that happens “somewhere else,” when in reality, it’s often undiagnosed or hidden behind other conditions.


One primary care provider said, “I’ve never had a patient bring it up.” After integrating a simple universal screening tool, she discovered that nearly 15% of her patients met criteria for opioid misuse. That included teachers, small business owners, retirees, and stay-at-home parents.

James was one of those patients. He was a 38 years old, well-groomed, compliant, and quietly battling a growing opioid dependence due to chronic back pain. He never disclosed it, and he was never asked. When his provider learned James had died of an overdose, he said, “I wish I had just asked.”


“I Don’t Have Time”


Time is tight for every provider. The idea of taking on patients who may need more support can feel overwhelming. But the assumption that patients suffering with OUD require more time isn’t always accurate.


Devon was 26 and recently completed residential treatment. He only needed a monthly Buprenorphine prescription and a provider willing to support his recovery. He was turned away by three clinics because they “weren’t accepting new MAT patients.” He relapsed shortly after…


With the right workflows, shared care models, and team-based support (like counselors, peers or case managers), OBOT can be seamlessly integrated into primary care, without overburdening the system. Providers often tell us, “These patients are the most grateful ones I treat.”


“My Practice Isn’t Set For That”


This concern often translates to self-imposed patient caps or confusion about infrastructure. One clinic I worked with had the capacity to treat 30 OBOT patients but capped themselves at 10 “to stay safe.”


Ebony called that clinic, desperate for help. They told her they were full. She ended up at a detox center, was discharged without follow-up, and relapsed a week later…


That same clinic later partnered with Vantage. We provided clinical templates, scheduling strategies, and mentoring. They now serve more than 100 patients safely and sustainably. Often, what’s needed isn’t a bigger setup, it’s a better system.


“I’m Not an Addiction Specialist”


Many providers feel that they should defer OUD treatment to addictionologists or pain clinics. That humility is admirable, but not always necessary.


Angela, a pregnant woman with opioid dependence, trusted her OB-GYN enough to share her situation. He referred her to a pain clinic with a three-week wait. She experienced severe withdrawal symptoms in the meantime and never made it to the appointment.


What she needed was someone she already trusted to help her begin treatment.


You don’t have to be an addiction expert to offer Buprenorphine. With access to clinical consultation lines, free training, and practical protocols, most providers can offer safe, effective care right away, and grow their knowledge over time.


“What Will My Colleagues (or My Patients) Think?”


Stigma doesn’t just touch patients, it touches providers, too. Some worry about being judged for “attracting the wrong crowd” or losing other patients.


Marcus had completed inpatient treatment and returned to his long-time provider for continued care. He was told, “That’s not something we do here.” He left feeling embarrassed and unsupported.


Later, the provider admitted the real concern was about reputation. But what many providers discover is that offering OBOT enhances their standing. Patients refer others. Colleagues seek advice. They become known not for addiction, but for compassionate, comprehensive care.


“What If They Divert or Misuse the Medication”


Buprenorphine diversion is a real concern, and it should be taken seriously. But research shows that most diversion occurs to prevent withdrawal, not to get high.


One provider stopped offering MAT after a single patient diverted medication (pills) years ago. That experience lingered…


When we reviewed tools like PDMP checks, patient agreements, the option of extended release injectable buprenorphine, random drug screening, and supervised dosing, he realized he had more control than he thought. With structure in place, he resumed prescribing and now treats over 40 patients successfully.


“What if I Get it Wrong?”


This concern often stems from fear of violating DEA rules or licensing board standards. Changing regulations, telehealth flexibilities, and documentation requirements can be confusing.


Dr. L, an experienced internist, told me: “I’m not afraid of the patient, i’m afraid of the paperwork.”


We walked through the current rules, provided compliance templates, and helped her onboard safely. Sometimes, it’s not about willingness, it’s about support and clarity.


“My Leadership Doesn’t Support It”


In some cases, the roadblock isn’t the provider, it’s the system. Without leadership buy-in, clinicians can be restricted by policy, billing limitations, or simple misalignment of priorities.


One provider was ready to launch OBOT, but her organization didn’t think it was worth the effort. After presenting data on reimbursement models, Medicaid incentives, and value-based care alignment, leadership changed course. That clinic now operates a robust, well-supported MAT program.


“I Don’t Have Access to Behavioral Health”


Some providers hesitate to offer Buprenorphine without counseling support. While integrated care is ideal, research confirms that medication alone reduces overdose risk significantly.


Marcus, for instance, didn’t need therapy right away, he needed stabilization. By starting Buprenorphine with a trusted provider and later adding peer support, he stayed in recovery and reconnected with his family.


Solutions like telehealth therapy, peer specialists, or external counseling partnerships can fill in the gaps.


Why Say Yes?


When providers say yes to Buprenorphine treatment, they’re not just prescribing, they’re opening a door. A door to hope, to dignity, to survival.


Saying yes can:


• Cut a patient’s overdose risk in half

• Improve retention in care

• Build trust and deepen the provider-patient relationship

• Align with value-based and whole-person care models

• Strengthen community health, and save lives


How Vantage Can Help


At Vantage Clinical Consulting, we specialize in helping providers build MAT programs that work clinically, operationally, and financially.


We provide:


• OBOT readiness assessments

• Implementation support

• Clinical tools and workflow templates

• Staff training and mentorship

• Compliance guidance

• Peer support connections

• Strategic leadership engagement


Not Sure Where to Start? Let’s Find Out Together.


If you’re considering offering or expanding Buprenorphine treatment, take our free MAT Readiness Self-Assessment. In just a few minutes, you’ll identify your strengths, opportunities, and what support might help you move forward with confidence.


It starts with one “yes.” One patient. One provider. One commitment to healing. And, we’ll be here to walk alongside you, every step of the way.


Disclaimer: The patient stories included in this article are composites drawn from real experiences gathered over the years. Names and some details have been changed to protect privacy.






 
 
 

Recent Posts

See All

Comments

bottom of page