Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Aug 1:225:108811.
doi: 10.1016/j.drugalcdep.2021.108811. Epub 2021 Jun 18.

Primary care physicians' preparedness to treat opioid use disorder in the United States: A cross-sectional survey

Kathryn Foti  1 , James Heyward  2 , Matthew Tajanlangit  3 , Kristin Meek  3 , Christopher Jones  4 , Andrew Kolodny  5 , G Caleb Alexander  6
Affiliations

Primary care physicians' preparedness to treat opioid use disorder in the United States: A cross-sectional survey

Kathryn Foti et al. Drug Alcohol Depend. .

Abstract

Background: Efforts to increase opioid use disorder (OUD) treatment have focused on primary care. We assessed primary care physicians' preparedness to identify and treat individuals with OUD and barriers to increasing buprenorphine prescribing.

Methods: We conducted a cross-sectional survey from January-August 2020 which assessed perceptions of the opioid epidemic; comfort screening, diagnosing, and treating individuals with OUD with medications; and barriers to obtaining a buprenorphine waiver and prescribing buprenorphine in their practice. Primary care physicians were sampled from the American Medical Association Physician Master File (n = 1000) and contacted up to 3 times, twice by mail and once by e-mail.

Results: Overall, 173 physicians (adjusted response rate 27.3 %) responded. While most were somewhat or very comfortable screening (80.7 %) and diagnosing (79.3 %) OUD, fewer (36.9 %) were somewhat or very comfortable treating OUD with medications. One third of respondents were in a practice where they or a colleague were waivered and 10.7 % of respondents had a buprenorphine waiver. The most commonly cited barriers to both obtaining a waiver and prescribing buprenorphine included lack of access to addiction, behavioral health, or psychiatric co-management, lack of experience treating OUD, preference not to be inundated with requests for buprenorphine, and the buprenorphine training requirement.

Conclusions: While most primary care physicians reported comfort screening and diagnosing OUD, fewer were comfortable treating OUD with medications such as buprenorphine and even fewer were waivered to do so. Addressing provider self-efficacy and willingness, and identifying effective, coordinated, and comprehensive models of care may increase OUD treatment with buprenorphine.

Keywords: Buprenorphine; Opioid use disorder; Primary care; Treatment.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest

GCA is past Chair of FDA’s Peripheral and Central Nervous System Advisory Committee; is a co-founding Principal and equity holder in Monument Analytics, a health care consultancy whose clients include the life sciences industry as well as plaintiffs in opioid litigation; and is a past member of OptumRx’s National P&T Committee. This arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies. The statements, findings, conclusions, views, and opinions contained and expressed herein are not necessarily those of IQVIA or any of its affiliated or subsidiary entities.

Figures

Fig. 1.
Fig. 1.
Physician comfort screening, diagnosing, and treating opioid use disorder. This figure shows the proportion of primary care physicians overall and the proportion of those who had treated at least one patient with OUD in the past year using any treatment modality who are very comfortable, somewhat comfortable, not very comfortable, or not at all comfortable screening for OUD, diagnosing OUD, and treating OUD with medications.
Fig. 2.
Fig. 2.
Physician confidence in the quality of care patients with opioid use disorder receive*. *Among those who had treated someone with OUD in the past year. Question not asked on web-based survey. (N = 83). Among primary care physicians who had treated at least one patient with OUD in the past year, this figure shows the proportion who were very confident, somewhat confident, not very confident, or not at all confident in the quality of care for OUD that their patients received in terms of timeliness, patient-centeredness, effectiveness, safety, and comprehensiveness.
See this image and copyright information in PMC

References

    1. Alter A, Yeager C, 2020. COVID-19 Impact on US National Overdose Crisis (Accessed 1.4.2021). http://odmap.org/Content/docs/news/2020/ODMAP-Report-May-2020.pdf.
    1. American Association for Public Opinion Research, 2016. Standard Definitions Final Dispositions of Case Codes and Outcome Rates for Surveys.
    1. Andrilla CHA, Coulthard C, Larson EH, 2017. Barriers rural physicians face prescribing buprenorphine for opioid use disorder. Ann. Fam. Med 15, 359–362. 10.1370/afm.2099. - DOI - PMC - PubMed
    1. Barry DT, Irwin KS, Jones ES, Becker WC, Tetrault JM, Sullivan LE, Hansen H, O’Connor PG, Schottenfeld RS, Fiellin DA, 2009. Integrating buprenorphine treatment into office-based practice: a qualitative study. J. Gen. Intern. Med 24, 218–225. 10.1007/sll606-008-0881-9. - DOI - PMC - PubMed
    1. Bipartisan Policy Center, 2019. Tracking Federal Funding to Combat the Opioid Crisis (Accessedl.4.2021). https://bipartisanpolicy.org/report/combating-the-opioid-crisis-2020/.

Publication types

MeSH terms