Bureaucratic hurdles and low Medicaid reimbursement rates are discouraging doctors from prescribing buprenorphine to treat opiate addictions, according to a survey from the Center for a Healthy Maryland.

The Baltimore Sun reported June 20 that barriers to broader use of buprenorphine cited by 17 doctors surveyed included insufficient reimbursement, medication reauthorization requirements, and confusing Medicaid protocols. Maryland's Medicaid program is operated by a group of seven managed-care organizations; the state is about to spend an additional $3 million on buprenorphine treatment.

"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, who said patients often travel hundreds of miles to get treatment at the school's hospital only to be blocked by managed care. "A few hours later, you'll get a call, and the patient will tell you that the pharmacy said the prescription wasn't authorized," said Welsh.

"It is a disorganized and chaotic system according to physicians," said Robert Schwartz, director of the treatment project at the Open Society Institute - Baltimore, which funded the survey.

The survey findings have prompted a group of doctors, state officials, and managed-care representatives to meet in hopes of improving treatment. "We have a real chance here to work together to deal with the concerns doctors have and the barriers they have told us about," said Meena R. Abraham, executive director of the Center for a Healthy Maryland.