Physicians Have Little Interest in Treating Patients With Opioid Use Disorder

Emma McGinty, PhD, MS

One-third of primary care physicians did not find medications to treat opioid use disorder to be more effective than nonmedication treatment or safe for long-term use, according to new survey results.

Emma McGinty, PhD, MS, and colleagues from Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Center for Mental Health and Addiction Policy Research conducted a national survey on a random sample of 1000 licensed physicians to examine their beliefs and attitudes about opioid use disorder medication. The team found that there should be new ways to implement addiction medicine practices into primary care facilities.

“Our findings suggest an urgent need to increase primary care physicians’ endorsement of the effectiveness of medication for (opioid use disorder) and their willingness to prescribe it,” the study authors wrote.

McGinty, an associate professor at Johns Hopkins Bloomberg School of Public Health, and the team of investigators used the American Medical Association Physician Masterfile database and mailed each physician a questionnaire with a $2 cash incentive. Participants were eligible if they were a family, internal, or general medicine practitioner and were actively practicing primary care at the address on file during the study period.

Physicians who did not respond were mailed the survey in 5 follow-up periods in March, April, June, July, and August 2019.

The survey included topics such as perceived effectiveness of opioid use disorder medications, opioid use disorder medication treatment practices, and support for policies related to opioid use disorder medication. To assess perceived effectiveness and policy items, the survey had a five-point Likert scale. A list of options was available to better understand a respondent’s current practice.

Overall, 668 physicians were eligible and 54% responded to the survey. The team did not see a difference in responses based on specialty, age, sex, degree, or practice type.

Two-thirds of respondents (67.1%) believed opioid use disorder treatment was more effective with medication than without and that patients could safely use medication to manage their disorder long-term (63.7%). What’s more, 77.5% of physicians perceived buprenorphine as more effective than methadone (62.1%) or injectable, extended-release naltrexone (51.4%).

Only 20.2% of physicians expressed interested in treating patients with opioid use disorder, while just 11.8% were interested in obtaining a buprenorphine waiver. Less than 10% reported that they prescribed buprenorphine (7.6%) or naltrexone (4%) for opioid use disorder.

Physicians did, however, support increasing insurance coverage of (81.8%) and government investment in (76 .4%) in opioid use disorder medication.

Less than half (47.7%) supported allowing physicians to prescribe methadone for the disorder in primary care settings or eliminating the buprenorphine waiver requirement (38%).

Although there has been conclusive evidence supporting continual medication use as the gold-standard treatment for opioid-use disorder, the survey findings highlighted that many primary care physicians still did not perceive such treatment to be more effective than nonmedication treatment.

The physician responses suggested that policy changes alone would not lead to widespread availability of primary care-based medication treatment of the disorder.

The study investigators emphasized that longer-term solutions including adding addiction medicine into physician training, and delivery system reforms, could be needed to help primary care physicians.

The study, “Medication for Opioid Use Disorder: A National Survey of Primary Care Physicians,” was published online in the journal Annals of Internal Medicine.