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Medication assisted treatment is a proven method to curb addiction. New research out of Ohio University finds one obvious place its not offered
By: David Forster
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ATHENS, Ohio (WOUB) — Southeast Ohio has been a ground zero for the addiction epidemic that’s claimed thousands of lives over the past decade. Medication assisted treatment has been proven to be an effective way to curb addiction and accidental fatal drug overdoses.
In some rural parts of the state, however, it can be hard to access without local medical specialists available to prescribe those medication. And primary care physicians seem to be hesitant to fill in the gaps.
Berkeley Franz is a professor of community-based health at Ohio University’s Heritage College of Osteopathic Medicine. She and a team of researchers wanted to know why this barrier exists and what it would take to break through it.
She sat down to speak with WOUB’s David Forster for “Modern Science.”
This interview has been edited for brevity and clarity.
On the focus of medication assisted treatment prescribed by primary care physicians
“We’re actually very lucky to have a medication that works really well for opioid use disorder. It prevents overdose deaths. It also prevents infectious disease transmission. But a lot of health care professionals are not willing to prescribe it. So a lot of patients are forced to seek this medication in specialty settings, either in a residential treatment center or through addiction medicine specialists, psychiatrists. Primary care is really an ideal setting to expand access to this medication and addiction treatment. More broadly, only 8 percent of family medicine physicians have ever prescribed this medication. It’s a real implementation challenge.”
How the study was conducted
“We presented primary care professionals licensed to practice here in Ohio with two different patient vignettes that were exactly the same, with the exception that one described a patient with opioid use disorder and one described a patient with Type 2 diabetes. But the patients were matched on all of their characteristics. And so they read a little description of the patient and their background,why they were coming to see them. Then they rated how willing they were to treat that patient in primary care versus refer to a specialist. They also rated their attitudes towards the patient as well as their attitudes towards the disease, how much they felt like the disease was within the patient’s control. We were trying to understand both how willing the providers were to do this in primary care, but also just how optimistic they were about this disease being treatable.”
Primary care physicians have conflicting attitudes toward medication assisted treatment for substance use disorder
“We actually found that attitudes towards addiction treatment were poor, which we sort of expected. We found that primary care providers were not very willing to provide this treatment in the primary care setting. But they actually had warmer attitudes towards patients with opioid use disorder than they did with patients with Type 2 diabetes. They thought Type 2 diabetes was actually more within the control of the patient, so they were more likely to blame the patient for their condition versus people with opioid use disorder. They also thought opioid use disorder was more treatable, which is also very surprising. It goes against a lot of the ideas that we have about stigma towards addiction treatment. So that’s interesting because the providers saw opioid use disorder as treatable. Yet there’s medication available to treat opioid use disorder, but very few primary care providers are prescribing it.”
“They still preferred to send patients outside to refer them to a specialist of some sort. That’s where the breakdown is happening. I think we’ve made some progress in terms of destigmatizing opioid use disorder. But still they themselves don’t feel either confident or willing to provide that treatment. Whereas they are confident and willing to provide treatment for Type 2 diabetes, despite seeing it as a more kind of complex illness.”
On what they learned and possible solutions
“I think what we learned is that stigma is important, probably for both of these illnesses. But in terms of interventions to improve access to this medication and improve access to treatment in primary care, I think we really have to address the kind of perception that addiction belongs there, that it is a medical problem, that these primary care providers are really trained and able to address. And some of it is a training problem. Primary care providers get very little training on how to treat addiction. Some of it’s a confidence problem. If you haven’t done it before, you’re not going to be very confident in doing it. I think what we are focusing on is trying to develop a model where this type of treatment is normalized. We’re actually pairing primary care providers in rural areas with other primary care providers who can provide mentorship on addiction training. Because what we do know from the science of this is that when you see somebody else doing this, you’re actually more confident and have more positive attitudes towards doing it in primary care.”
“We think that might be key to expanding access in this region where we just don’t have a lot of specialists. That’s not an option for most people here. Transportation is [also] a very important barrier. That’s another reason not to send patients to multiple settings for treatment they could receive in the same location. That’s going to really limit the ability of patients to either have to choose, do you want to get your flu shot and any other chronic disease addressed, or do you want to receive addiction treatment? We really need to normalize addiction treatment as just part of healthcare and not make it more difficult and put more barriers in place for people to receive evidence-based health care.”
The first draft of the transcript used for this story was created in Adobe Podcast, which includes an AI transcription tool. A WOUB news editor then reviewed, corrected and reformatted the transcript before publication.