Results from a national survey indicate that many Americans, 61%, are unaware that primary care physicians can prescribe medications for opioid use disorder, and 13% incorrectly believed that they could not. The survey, funded by the National Institutes of Health (NIH), also found that 82% of the people who reported ever misusing prescription or illicit opioids expressed comfort in going to their primary care physicians for medications for opioid use disorder. Among those who had not misused opioids, a majority, 74%, reported they would be comfortable referring their loved ones to primary care for these medications.
Notably, Black American respondents were most likely to incorrectly believe they could not receive medications for opioid use disorder via primary care, pointing to an important disparity in information that may further impede access to treatment. The findings suggest there is an important opportunity to increase awareness of these treatments and how to access them – using efforts that employ culturally specific strategies to reach different groups. Decades of research have shown the overwhelming benefit of existing medications for opioid use disorder, such as buprenorphine and methadone.
"Primary care is often people's first point of contact in the health care system and can serve as a crucial setting to talk about addiction and receive lifesaving medications," said Nora D. Volkow, M.D., Director of NIH's National Institute on Drug Abuse (NIDA). "We need to provide education and support so that patients feel empowered to seek help from their primary care physician, and their doctors feel prepared to help them."
Recent federal policy changes have removed some barriers to prescribing buprenorphine by primary care physicians, such as specialized training requirements (elimination of the X-waiver in 2023) and patient caps. Despite these changes, there remain barriers to receiving medication for opioid use disorder. A recent study found that, in the year after elimination of the waiver requirement to prescribe buprenorphine, the number of prescribers increased, but the number of persons who received the medication did not.
Studies estimate that fewer than 2,500 physicians specialize in addiction medicine in the U.S. With approximately 209,000 primary care physicians in the U.S., channeling addiction treatment through primary care could have a significant public health impact.
Researchers at Brown University, Providence, Rhode Island, hypothesized that public health factors may impede access to these medications. They formulated survey questions on people's awareness of and comfort around opioid use disorder treatment in primary care. In collaboration with NIDA, the researchers added these questions to a survey conducted in English and Spanish by the Justice Community Opioid Innovation Network (JCOIN), led by NIDA and supported through The NIH Helping to End Addiction Long-term Initiative, or NIH HEAL Initiative. JCOIN researchers administered this survey in June 2023, targeting a nationally representative sample of adults aged 18 and older.
Among 1,234 respondents, 57% were female, 43% were male, 12% were Black, 15% were Hispanic/Latino, 68% were white, and 5% reported other or two or more races. Most respondents agreed (53%) or strongly agreed (24%) that the office of a primary care physician should be a place where people can receive treatment for an opioid use disorder.
"We've made great strides in making it easier for primary care doctors to prescribe these safe and effective treatments, but our study indicates a critical disconnect between the need for medications for opioid use disorder and people's knowledge about how to access them," said Brandon del Pozo, Ph.D., assistant professor at the Warren Alpert Medical School of Brown University and Brown University School of Public Health and lead author on the study. "Science, public health, insurance, policy, and public perception all must align to improve access to treatment."
The authors note that future research should explore targeted strategies to enhance public awareness and investigate the impact of increased primary care physicians' involvement in providing medications for opioid use disorder. Awareness campaigns akin to those for HIV testing and cancer screening – including educational materials in medical settings and proactive screening by primary care physicians – may help address this gap in public knowledge. By increasing public awareness and demand, primary care physicians may be more incentivized to offer medications for opioid use disorder, especially with appropriate clinical and administrative support, the authors say.
This study, published in JAMA Network Open, was supported by NIDA, with additional support from NIH's National Institute of General Medical Sciences.
The NIH Helping to End Addiction Long-termSM and NIH HEAL InitiativeSM are registered service marks of the Department of Health and Human Services.
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Reference: B del Pozo, et al. Knowledge, attitudes, and beliefs of US adults about opioid use disorder treatment in primary care. JAMA Network Open. DOI: 10.1001/jamanetworkopen.2024.19094 (2024).
