Buprenorphine office-based opioid maintenance is an increasingly common form of 
treatment for opioid use disorders. However, total prescribing has not kept pace 
with the current opioid and overdose epidemic and access remains scarce among 
the underserved. This study sought to assess current provider attitudes and 
clinical practices among a targeted sample of primarily New York City public 
sector buprenorphine prescribers. A cross-sectional online survey purposefully 
sampled buprenorphine prescribers in NYC with a focus on those serving Medicaid 
and uninsured patient populations. Expert review of local provider networks, 
snowball referrals, and in-person networking generated an email list, which 
received a survey link. A brief 25-question instrument queried provider and 
practice demographics, prescribing practices including induction approaches and 
attitudes regarding common hot topics (e.g., buprenorphine diversion, prescriber 
patient limits, insurance issues, ancillary treatments). Of 132 email 
invitations, N=72 respondents completed (n=64) or partially completed (n=8) the 
survey between January and April 2016. Most (79%) were Medicaid providers in 
non-psychiatric specialties (72%), working in a hospital-based or community 
general practice (51%), and board-certified in addiction medicine or psychiatry 
(58%). Practice sizes were generally 100 patients or fewer (71%); many providers 
(64%) individually prescribed buprenorphine <25% of total practice time to a 
median 23 patients (mean 31, range 0-102). Unobserved (home) induction for new 
patients was a common practice: 49% predominantly prescribed unobserved 
induction; 16% mixed unobserved and observed inductions. Adjunctive psychosocial 
counseling was routinely recommended (46%) or considered on a case-by-case basis 
(17%) versus mandated (37%). Medication prior authorization requirements were 
the highest rated barriers to practice, followed by inadequate clinic space, 
limited clinic time and/or support staff, and inadequate psychiatric services 
for dual diagnoses. Buprenorphine diversion was not rated as an important 
practice barrier. In conclusion, this targeted survey of buprenorphine 
prescribers in NYC treating primarily underserved populations showed a 
consistent pattern of part-time prescribing to modest volumes of patients, 
routine use of unobserved buprenorphine induction, and primarily elective 
referrals to psychosocial counseling. Barriers to prescribing included prior 
authorization requirements, lack of clinical resources (space, staff) and 
psychiatric services. Federal and local efforts to reduce such barriers may 
improve buprenorphine access among the underserved.