One-third of primary care physicians do not support medications for opioid use disorder

One-third of primary care physicians did not perceive medications to treat opioid use disorder (OUD) to be more effective than nonmedication treatment or safe for long-term use, despite conclusive evidence to the contrary, a survey found.

Physicians also reported low interest in treating OUD and low support for policy proposals allowing office-based physicians to prescribe buprenorphine and methadone. The results were published as a brief research report on April 21 by Annals of Internal Medicine.

Researchers surveyed a random sample of 1,000 licensed physicians selected from the American Medical Association Physician Masterfile. Of 336 respondents, two-thirds believed that treatment of OUD is more effective with medication than without (67.1%) and that patients can safely use medication to manage OUD in the long term (63.7%). One-fifth (20.2%) of physicians expressed interest in treating patients with OUD.

Physicians were more likely to perceive buprenorphine (77.5%) as effective than methadone (62.1%) or injectable, extended-release naltrexone (51.4%). Few reported prescribing buprenorphine (7.6%) or naltrexone (4.0%) for OUD, and few expressed interest in obtaining a buprenorphine waiver (11.8%). Most physicians supported increasing insurance coverage of and government investment in OUD medication (81.8% and 76.4%, respectively), but fewer than half supported allowing physicians to prescribe methadone for OUD in primary care settings (47.7%) or eliminating the buprenorphine waiver requirement (38.0%).

The researchers urged efforts to increase primary care physicians' acceptance of and willingness to prescribe medications for OUD. “These findings suggest that policy changes alone are unlikely to lead to widespread availability of primary care-based medication treatment of OUD,” they wrote. “Longer-term solutions, such as incorporating addiction medicine into physician training, and delivery system reforms, such as embedding addiction medicine professionals in primary care practices, may be needed.”