A new survey of U.S. primary care physicians from researchers at Johns Hopkins Bloomberg School of Public Health found that nearly one-third, 32.9 percent, do not think treating opioid use disorder with medication is any more effective than treatment without medication.
The study also found that only one-fifth, 20.2 percent, of U.S. primary care physicians have interest in treating a patient with opioid use disorder.
The study, published online April 21 in the Annals of Internal Medicine, suggests that despite efforts to expand treatment for opioid use disorder with medication, some physicians in primary care settings remain reluctant to support medication as a treatment option.
This reluctance contrasts with research that shows that treatment with one of the three FDA-approved medications for opioid use disorder--methadone, buprenorphine, or naltrexone--is far more effective at helping people recover and preventing overdose death than approaches that do not use medication.
"Expanding treatment for patients with opioid use disorder is a public health priority," says Beth McGinty, PhD, associate professor in the Bloomberg School's Department of Health Policy and Management and the paper's lead author. "Primary care physicians present an important opportunity to address the huge gaps in treatment for opioid use disorder in the U.S. It is concerning that so many primary care physicians do not view medication as effective, despite strong research evidence and clinical guidelines emphasizing that treatment with medication saves lives."
There are an estimated 2.1 million people in the U.S. with an opioid use disorder. Recent studies have shown almost two-thirds of individuals with opioid use disorder do not receive any treatment.
For the survey, the researchers fielded a survey in February 2019 to 1,000 randomly selected primary care physicians in the U.S. using the American Medical Association Physician Masterfile, a database of all U.S. licensed physicians.
From the sample, researchers identified 688 eligible physicians, including actively practicing family, internal, or general medicine practitioners. Physicians were mailed a survey, instructions for return, and a $2 dollar cash incentive. Survey questions measured perceived effectiveness of opioid use disorder medication, prescribing practices for medication, and support for policies related to treating opioid use disorder.
The analysis, based on 361 survey responses, found low support for policies that remove prescription barriers for physicians in office settings. Currently physicians in non-hospital settings who want to prescribe buprenorphine to treat opioid use disorder must file paperwork for authorization with the Substance Abuse and Mental Health Services Administration (SAHMSA), and methadone treatment is only available in specialty clinics. Nearly half of respondents, 47.7 percent, supported allowing methadone to be prescribed in primary care settings, and only 38 percent supported policies around eliminating the waiver requirement.
"There are proposals out there to change policies to make it easier for primary care physicians to prescribe medications to treat opioid use disorder," says McGinty. "Yet we found that the majority of primary care physicians do not support these policies."
More than three-fourths of respondents (77.5 percent) thought buprenorphine was the most effective medication as compared to methadone (62.1 percent) and injectable, extended-release naltrexone (51.4 percent). Only 7.6 percent of physicians reported ever prescribing buprenorphine and even less (4 percent) reported prescribing naltrexone.
Most respondents (81.8 percent) supported increasing insurance coverage to cover treatment for opioid use disorder medication and 76.4 percent supported increasing government investment in medication-assisted treatment.
"Medication for Opioid Use Disorder: A National Survey of Primary Care Physicians" was written by Emma E. McGinty, Elizabeth M. Stone, Alene Kennedy-Hendricks, Marcus A. Bachhuber, and Colleen L. Barry.
The study was supported by a Johns Hopkins University Frontier Award.