Program boosts PCPs’ confidence in prescribing OUD treatment
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Key takeaways:
- The medication-assisted treatment program supplements X waiver training.
- The researchers’ next step will be to assess the impact of hands-on experience in addition to training.
A medication-assisted treatment, or MAT, supplemental training program improved primary care physicians’ confidence and willingness to implement MAT for opioid use disorder, a recent study found.
“The availability and potency of synthetic drugs, frequently combined with other substances, has resulted in a public epidemic characterized by overdose and death,” Stacey L. Gardner-Buckshaw, PhD, MPA, an assistant professor of family and community medicine at Northeast Ohio Medical University (NEOMED), and colleagues wrote. “To tackle this problem, the primary care workforce needs to be involved in treating people with [opioid use disorder (OUD)].”
Data derived from: Gardner-Buckshaw S, et al. J Am Board Fam Med. 2023;doi:10.3122/jabfm.2022.220281R2.
Despite an increasing number of physicians obtaining a waiver to prescribe buprenorphine, known as the X waiver, the researchers wrote that “only 3.6% of family medicine physicians in the nation have this certification.”
During the COVID-19 pandemic, new federal rules emerged allowing eligible providers to prescribe buprenorphine to up to 30 patients without undergoing X waiver training. However, without training, PCPs have “expressed negative attitudes” and “may continue to be resistant to treating OUD,” Gardner-Buckshaw and colleagues wrote.
In response, researchers at NEOMED and MetroHealth, a health system in Ohio, developed a 4-hour training program designed to supplement the 8-hour MAT certification training program sponsored by the Substance Abuse and Mental Health Services Administration. The supplemental program was made up of three training modules, including:
- office-based treatment with buprenorphine;
- philosophy of care and addiction as a brain disease; and
- motivational interviewing.
The researchers examined outcomes associated with the supplemental program through pre- and post-intervention surveys, which gauged participants’ knowledge, abilities and attitude on MAT training and implications.
Of the 203 PCPs who attended training sessions from February 2018 to June 2019, 183 completed survey responses. Gardner-Buckshaw and colleagues found that pre- and post-intervention comparisons revealed:
- a significant increase in participants’ level of confidence and willingness in implementing the MAT process;
- a small increase in confidence during interactions with patients receiving MAT; and
- small increases in participants’ perceptions of the importance of patient interactions and the care process.
A follow-up survey (n = 65) also found that 57% of trainees had implemented MAT into their practices, while 19% had plans to do so.
“Reasons for not (or not yet) implementing MAT included uncertainty of future practice location, disinterest from colleagues or other care team members, or uncertainty about legal consequences associated with treating patients with addiction,” Gardner-Buckshaw and colleagues wrote. “Even those who did not choose to prescribe found value in the training for patient education and referral purposes.”
Among the study limitations included the program being delivered in a single region, potentially affecting the generalizability for other physicians across the country.
According to Gardner-Buckshaw and colleagues, the next phase of this research will be to evaluate the impact of hands-on clinical experiences in addition to MAT plus primary care supplemental training.
“Now that the rules have been relaxed, further studies are needed to determine if PCPs with waiver training are more likely to treat OUD compared with PCPs without training,” they wrote.
Perspective
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Anita Gupta, DO, PharmD, MPP, GMP, FASA
The opioid crisis has continued to impact communities throughout the United States, claiming lives and leaving many communities devastated. More than 932,000 people have died since 1999 from a drug overdose. Nearly 75% of drug overdose deaths in 2020 involved an opioid. With this level of demand, the illicit drug market has quickly responded by developing cheaper alternatives to prescription opioids. These substances are often 50 to 100 times stronger than fentanyl and other common prescription opioids. As a result, they pose a much larger risk to users — and to society. Overdose deaths involving opioids, including prescription opioids, heroin and synthetic opioids (like fentanyl), have increased by more than eight times since 1999. Overdoses involving opioids killed nearly 69,000 people in 2020, and more than 82% of those deaths involved synthetic opioids.
These statistics demonstrate the ongoing public health crisis related to opioid use and overdoses in the United States. The article presents an argument for the need to increase the utilization of MAT for OUD in primary care settings. The authors effectively communicate the severity of the opioid crisis and the potential benefits of MAT. According to this research, there are significant barriers to equitable access to MAT in primary care, including lack of provider training, stigma around MAT, limited access to MAT medications and inadequate reimbursement for MAT services. Increasing provider education, improving care coordination and addressing stigma are key strategies for increasing MAT utilization in primary care.
Overall, the article effectively communicates the need to increase MAT utilization in primary care settings. However, a more in-depth analysis of the barriers to MAT and the proposed strategies to overcome them would have strengthened the article's argument and provided a more comprehensive picture of the challenges facing primary care providers who wish to offer MAT.
Adjunct assistant professor, Johns Hopkins School of Medicine
Member, Healio Primary Care Peer Perspective Board
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