Primary care physicians' preparedness to treat opioid use disorder in the United States: A cross-sectional survey.
Buprenorphine
Opioid use disorder
Primary care
Treatment
Journal
Drug and alcohol dependence
ISSN: 1879-0046
Titre abrégé: Drug Alcohol Depend
Pays: Ireland
ID NLM: 7513587
Informations de publication
Date de publication:
01 08 2021
01 08 2021
Historique:
received:
04
02
2021
revised:
27
04
2021
accepted:
29
04
2021
pubmed:
28
6
2021
medline:
23
9
2021
entrez:
27
6
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 34175786
pii: S0376-8716(21)00306-9
doi: 10.1016/j.drugalcdep.2021.108811
pmc: PMC10659122
mid: NIHMS1912671
pii:
doi:
Substances chimiques
Buprenorphine
40D3SCR4GZ
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
108811Subventions
Organisme : Intramural CDC HHS
ID : CC999999
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier B.V. All rights reserved.
Références
Addiction. 2019 Mar;114(3):471-482
pubmed: 30194876
N Engl J Med. 2018 Jul 5;379(1):4-6
pubmed: 29972745
J Gen Intern Med. 2007 Sep;22(9):1325-9
pubmed: 17619934
Am J Public Health. 2015 Aug;105(8):e55-63
pubmed: 26066931
Harm Reduct J. 2020 May 6;17(1):26
pubmed: 32375887
JAMA Psychiatry. 2017 May 1;74(5):445-455
pubmed: 28355458
Am J Addict. 2017 Jun;26(4):316-318
pubmed: 28394437
J Clin Psychiatry. 2016 Jun;77(6):772-80
pubmed: 27337416
Am J Prev Med. 2018 Jun;54(6 Suppl 3):S230-S242
pubmed: 29779547
Drug Alcohol Depend. 2017 Apr 01;173 Suppl 1:S55-S64
pubmed: 28363321
JAMA. 2021 Mar 23;325(12):1149-1150
pubmed: 33630021
Health Aff (Millwood). 2015 Mar;34(3):484-92
pubmed: 25732500
NAM Perspect. 2020 Apr 27;2020:
pubmed: 35291732
JAMA Intern Med. 2015 Feb;175(2):302-4
pubmed: 25485657
Ann Intern Med. 2020 Jul 21;173(2):160-162
pubmed: 32311740
Drug Alcohol Depend. 2019 Apr 1;197:78-82
pubmed: 30784952
Ann Fam Med. 2014 Mar-Apr;12(2):128-33
pubmed: 24615308
Ann Fam Med. 2017 Jul;15(4):359-362
pubmed: 28694273
J Gen Intern Med. 2009 Feb;24(2):218-25
pubmed: 19089500
JAMA. 2021 Mar 23;325(12):1147-1148
pubmed: 33630020
Transcult Psychiatry. 2016 Aug;53(4):465-87
pubmed: 27488225
J Subst Abuse Treat. 2020 Dec;119:108146
pubmed: 33138929
JAMA. 2019 Apr 16;321(15):1446-1447
pubmed: 30990541
Clin J Pain. 2016 Apr;32(4):279-84
pubmed: 26102320
J Addict Med. 2017 Jul/Aug;11(4):286-292
pubmed: 28379862
J Subst Abuse Treat. 2017 Jul;78:1-7
pubmed: 28554597
JAMA Psychiatry. 2019 Mar 1;76(3):229-230
pubmed: 30586140