Nearly a third of primary care physicians (PCPs) do not perceive opioid use disorder (OUD) medication treatment to be more effective than nonmedication treatment despite the availability of conflicting evidence, according to a research report published in the Annals of Internal Medicine. The report states that more than 65% of patients with OUD in the United States do not receive treatment with buprenorphine, methadone or injectable extended release naltrexone, all US Food and Drug Administration approved medications.
Researchers from the Johns Hopkins Bloomberg School of Public Health and Center for Mental Health and Addiction Policy Research in Baltimore, Maryland mailed surveys to a nationally representative, random sample of 1000 US physicians from the American Medical Association Physician Masterfile in February 2019. Eligible physicians for the study were identified as actively practicing family, internal, or general medicine practitioners. The survey contained questions regarding perceived effectiveness of OUD medications, OUD medication treatment practices, and level of support for policies related to OUD medication. Effectiveness and policy related responses were evaluated using 5-point Likert scales.
Of 668 eligible PCPs, 54% (n=361) gave responses. Surveys missing more than 50% of data were excluded (n=25), leaving 336 PCP responses to be used for study results. Whereas 67.1% of PCPs believe OUD treatment is more effective with medication than without, 63.7% believe long term medication use is safe to manage OUD. Buprenorphine was perceived to be more effective by PCPs (77.5%) than methadone (62.1%) or injectable extended-release naltrexone (51.4%).
A fifth of PCPs showed interest in treating patients with OUD (20.2%), while a few PCPs reported prescribing buprenorphine (7.6%) or naltrexone (4.0%) and a few reported interest in obtaining a buprenorphine waiver (11.8%).
Most of those surveyed supported increasing insurance coverage of OUD medication (81.8%) as well as government investment in OUD medication (76.4%). However, less than half supported PCPs prescribing methadone for OUD in primary care settings (47.7%) or eliminating buprenorphine waiver requirements (38.0%).
“These findings suggest that policy changes alone are unlikely to lead to widespread availability of primary care-based medication treatment of OUD,” the researchers stated. Incorporating addiction medicine into physician training and adding addiction medicine professionals in primary care practices are suggested. “Our findings suggest an urgent need to increase primary care physicians’ endorsement of the effectiveness of medication for OUD and their willingness to prescribe it.”
McGinty E, Stone E, Kennedy-Hendricks A, Bachhuber MA, Barry CL. Medication for opioid use disorder: a national survey of primary care physicians [published online April 20, 2020]. Ann Intern Med. doi:10.7326/M19-3975