Maryland has probably done more than any state to promote use of the anti-opiate drug buprenorphine, but many doctors in the state remain unwilling to prescribe the drug, the Baltimore Sun reported July 20.

The Center for a Healthy Maryland, Inc., released a survey showing that doctors cited a variety of obstacles to using the drug, which, unlike methadone, can be prescribed at individual doctors' offices. Stumbling blocks include low Medicaid payments, bureaucratic hassles such as preauthorization requirements, confusing regulations, negative attitudes about drug users, and unfamiliarity in dealing with addicted patients.

"One of the biggest barriers to prescribing buprenorphine is dealing with the insurance companies," said Christopher Welsh of the University of Maryland School of Medicine in Baltimore, who has some clients who drive for hours in hopes of getting the drug. "A few hours later, you'll get a call, and the patient will tell you that the pharmacy said the prescription wasn't authorized." Calling health plans can often result in doctors getting "passed from voice mail to voice mail," he added.

"It is clear that it is more than insurance," said Susan Tucker, executive director of the Office of Health Services for the Maryland Medicaid Program. "Some doctors don't feel comfortable providing counseling for patients; some don't feel they have the background."

Only a quarter of the 17 doctors surveyed said they would prescribe buprenorphine.

"It is a disorganized and chaotic system according to physicians," said Robert Schwartz, director of drug addiction treatment programs at the Open Society Institute in Baltimore. The findings have prompted a pledge from doctors and managed-care firms to work together to improve treatment opportunities.