Background Long-acting injectable buprenorphine (LAI-BUP) is safe and effective, however is dramatically underutilized in comparison to oral formulations. Little is known regarding how buprenorphine prescribers view LAI-BUP, and which medication attributes they prioritize when selecting treatment for opioid use disorder (OUD).

Methods A secondary analysis of a national, cross-sectional online survey of U.S. physicians who prescribe buprenorphine for OUD was conducted. Respondents reported OUD caseload, LAI-BUP use, and the importance of medication attributes relevant to treatment selection (e.g., efficacy, safety, ease of administration, ease of prescribing, and administrative requirements). Providers were categorized as no LAI-BUP use or, among LAI-BUP prescribers, Low vs High use based on a median split. Group comparisons used chi-square (or Fisher’s exact) tests for categorical variables and Jonckheere–Terpstra tests for ordinal responses.

Results Among 125 respondents, 39 (31.2%) reported no patients receiving LAI-BUP. The remaining 86 (68.8%) were LAI-BUP prescribers, split evenly into Low and High (n’s=43; 34.4%) groups using a median cut of 23.2%. LAI-BUP use did not differ meaningfully by specialty, region, or practice setting. Greater LAI-BUP use was reported by providers with larger OUD panels. Ratings of key medication attributes were uniformly high.

Conclusions LAI-BUP remains underused, with uptake highest among clinicians managing larger OUD caseloads. Measured attitudes toward medication attributes did not explain these differences. Future work should assess clinic workflow, staffing, reimbursement, and REMS burden, testing targeted implementation strategies using mixed-methods trials. Identifying what shifts clinicians from no use to low and high use may guide scalable implementation interventions.

Oesterle provides consultative services to Koa Health and Frenelle Pharma. Oesterle has not received any compensation for these services. All other authors are employed by their respective institutions as noted. No other author discloses any financial and personal relationships with other people or organizations that could inappropriately influence or bias their work.

The study was funded by Frenelle Pharma, including developing the survey and funding participant remuneration. The sponsor did not compensate the authors and had no role in manuscript writing. The authors performed the analyses and interpreted the findings independently.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Institutional Review Board for Human Subjects Research of Frenelle Pharma gave ethical approval for this work, and informed consent was obtained from all participants.

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Declarations of interest: Oesterle provides consultative services to Koa Health and Frenelle Pharma. Oesterle has not received any compensation for these services. All other authors are employed by their respective institutions as noted. No other author discloses any financial and personal relationships with other people or organizations that could inappropriately influence or bias their work.

All data discussed in this manuscript are available upon reasonable request to the authors.