Primary care physicians (PCPs), a frequent, convenient, nonstigmatized touchpoint with health care, hold promise for expanding access to buprenorphine, the only office-based medication for opioid use disorder (MOUD) with demonstrated effectiveness in reducing overdose mortality.1 To expand buprenorphine-based treatment, federal policy has eliminated specialized training requirements for prescribing physicians and lifted patient caps. A wide gap remains, however, between buprenorphine need and provision in primary care settings.2
Research has explored barriers and facilitators of MOUD from physicians’ perspectives.3 While evidence suggests patients may respond favorably to MOUD in primary care settings,4,5 we know little of their awareness that MOUD can be prescribed there or opinion of whether PCPs ought to provide MOUD, whether patients would seek it, and whether they would refer someone to their PCP to obtain it. This survey study explored these questions.
Data were obtained from a June 2023 cross-sectional survey for the Justice Community Opioid Innovation Network. The survey was administered in English and Spanish and offered online and by telephone to a probability-based, nationally representative sample of adults 18 years or older drawn from the National Opinion Research Center’s (NORC) AmeriSpeak panel. The NORC Institutional Review Board deemed this study exempt from review. Consent was obtained orally from telephone participants and electronically from online participants. We followed the AAPOR reporting guideline.
Analyses were performed with Stata 15.0 (StataCorp). Weighted Pearson χ2 tests and ad hoc regression were used, with prespecified 2-tailed significance of P < .05. Survey items and weighting methods are presented in the eAppendix in Supplement 1. Race and ethnicity data were collected to examine the relevant demographic differences in participant responses.
A total of 1234 individuals responded (700 females [56.5%], 539 males [43.5%]; 11.5% identifying as Black, 15.2% as Hispanic or Latino, 68.4% as White, and 4.8% as other or with ≥2 race and ethnicity; ages were reported categorically to protect confidentiality) (Table 1). Most respondents either did not know a PCP could treat people with an opioid use disorder (OUD) by prescribing MOUD (61.4% weighted) or incorrectly believed a PCP could not (13.3% weighted). Most respondents agreed (658 [53.9%]) or strongly agreed (309 [24.9%]) that a PCP office should be a place where people can receive OUD treatment (Table 2).
Among respondents who reported ever misusing prescription or illicit opioids, 50.6% (weighted) said they would be very comfortable and 30.7% (weighted) would be somewhat comfortable personally seeking MOUD from their PCP. Of the respondents with no history of opioid misuse, 31.9% (weighted) said they would be very comfortable and 42.0% (weighted) would be somewhat comfortable referring someone they cared about to their PCP for MOUD (Table 2). In aggregate, Black respondents (20.9% weighted) were most likely to believe they could not receive MOUD at a PCP (Table 1).
The findings suggest most respondents did not know a PCP can provide MOUD. Raising awareness that PCPs can is critical to increasing effective treatment of OUD and reducing the race-and-ethnicity–based disparities in knowledge about MOUD access observed in this study. Interventions could include messaging campaigns similar to those for HIV testing and cancer screening. Literature and signage about MOUD could be placed in waiting areas and examination rooms. PCPs could proactively screen patients for OUD and offer to prescribe MOUD as indicated. Measures to raise awareness about the opportunity to receive MOUD from PCPs may increase demand and incentivize PCPs to offer MOUD, especially if accompanied by clinical and administrative support, such as access to addiction medicine consultations.6
Limitations are inherent in probability-based weighted samples and respondents’ understanding of MOUD. However, our methods found the approximately 209 000 PCPs in the US positioned to play a decisive role in expanding access to buprenorphine. Increasing the public’s knowledge of this potential may help convert it to action.
Accepted for Publication: April 26, 2024.
Published: June 28, 2024. doi:10.1001/jamanetworkopen.2024.19094
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2024 del Pozo B et al. JAMA Network Open.
Corresponding Author: Brandon del Pozo, PhD, MPA, MA, Rhode Island Hospital, DGIM Research, 111 Plain St, Providence, RI 02903 (bdelpozo@lifespan.org).
Author Contributions: Drs Park and del Pozo had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: del Pozo, Park, Taylor, Wakeman, Ducharme, Rich.
Acquisition, analysis, or interpretation of data: del Pozo, Park, Taylor, Wakeman, Ducharme, Pollack.
Drafting of the manuscript: del Pozo, Taylor, Wakeman, Pollack.
Critical review of the manuscript for important intellectual content: Park, Taylor, Wakeman, Ducharme, Pollack, Rich.
Statistical analysis: Park, Pollack.
Obtained funding: Taylor, Pollack.
Administrative, technical, or material support: Taylor, Pollack.
Supervision: Taylor, Rich.
Conflict of Interest Disclosures: Dr del Pozo reported receiving grants from the National Institute on Drug Abuse (NIDA) during the conduct of the study. Dr Taylor reported receiving grants from the NIDA during the conduct of the study. Dr Wakeman reported receiving personal fees from UpToDate, Springer, and Celero Systems outside the submitted work. Dr Ducharme reported being the assigned Science Officer for the NIDA cooperative agreement supporting this survey. Dr Pollack reported receiving grants from the NIDA during the conduct of the study. Dr Rich reported receiving grants from the National Institute of General Medical Sciences (NIGMS) during the conduct of the study and personal fees from the Drug Policy Alliance outside the submitted work. No other disclosures were reported.
Funding/Support: This study was supported by grants K01DA056654 (Dr del Pozo) and U2CDA050098 (Drs Taylor and Pollack) from the NIDA and by grant P20GM125507 from the NIGMS (Drs Park and Rich).
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Data Sharing Statement: See Supplement 2.
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