One-third of PCPs question efficacy of medications for opioid use disorder
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In a recent survey, about one-third of primary care physicians felt that medications for opioid use disorder such as buprenorphine were no more effective than nonmedication treatments, despite evidence supporting their use as the “gold standard” treatment, researchers said.
“We wanted to understand primary care physicians’ views about treating opioid use disorder (OUD) with medication,” Beth McGinty, PhD, associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, told Healio Primary Care.
McGinty and colleagues analyzed responses from 336 PCPs from the AMA’s Physician Masterfile who answered questions about OUD treatment. The findings, published in Annals of Internal Medicine, showed that:
- 61.7% believed that treatment of OUD is more effective with medication than without;
- 63.7% felt patients should use medication to manage OUD;
- 20.2% expressed an interest in treating patients with the condition;
- 11.8% wished to obtain a buprenorphine waiver;
- 81.8% supported increasing insurance coverage of OUD treatment;
- 47.7% felt physicians should prescribe methadone for the condition in primary care settings; and
- 38% endorsed removing the buprenorphine waiver requirement.
McGinty said there is the “big push nationwide to do a much better job integrating addiction treatment into the general medical system.” Additionally, she said, the findings from the survey underscore the need to incorporate training in the primary care setting for addiction treatment — including but not limited to OUD. – by Janel Miller
Disclosures: McGinty reports receiving professional relationships with the Bipartisan Policy Center, CDC, Consortium for Risk-Based Firearm Policy, the Laura and John Arnold Foundation, National Institute of Mental Health, National Institute on Drug Abuse, the United States Department of Defense, the U.S. Department of Veteran Affairs and the United Nations. No other relevant financial disclosures were reported.
Perspective
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Antoine Douaihy, MD
To have a third of PCPs not see that medication treatments for OUD are really effective is disturbing.
To me, the findings indicate that PCPs do not want to work with people who have addictions, particularly opioid addictions. We know that the issue of stigma is out there among health care practitioners on societal and institutional levels. But how do you remove that in non-addiction settings, such as primary care clinics? We need to start looking at OUD as a chronic illness as any other medical illnesses that deserves a really aggressive chronic course of treatment. And we have to start believing that treatment works. PCPs who have been practicing for years and years have very fixed beliefs. I would not confront them. I would challenge these misbeliefs that treatments for opioid use disorders don’t work. Listen to what their concerns are to see if they would consider learning more and getting the training and the supervision that they need to break the barriers to treat people with opioid addiction, that they and our society have established.
We have compelling evidence that medications for opioid use disorder such as methadone and buprenorphine as well extended release naltrexone are effective. Would you not consider a medication that works very well and save lives when you're treating somebody who has diabetes? How is that really different than if you were to be thinking about somebody who has an OUD and not prescribe that medication?
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