Facilitators and barriers to utilization of medications for opioid use disorder in primary care in South Carolina

Abstract

Objective Utilization of medications for opioid use disorder (MOUD) has not been widely adopted by primary care providers. This study sought to identify interprofessional barriers and facilitators for use of MOUD (specifically naltrexone and buprenorphine) among current and future primary care providers in a southeastern academic center in South Carolina. Method Faculty, residents, and students within family medicine, internal medicine, and a physician assistant program participated in focus group interviews, and completed a brief survey. Survey data were analyzed quantitatively, and focus group transcripts were analyzed using a deductive qualitative content analysis, based upon the theory of planned behavior. Results Seven groups ( N = 46) completed focus group interviews and surveys. Survey results indicated that general attitudes towards MOUD were positive and did not differ significantly among groups. Subjective norms around prescribing and controllability (i.e., beliefs about whether prescribing was up to them) differed between specialties and between level of training groups. Focus group themes highlighted attitudes about MOUD (e.g., “opens the flood gates” to patients with addiction) and perceived facilitators and barriers of using MOUD in primary care settings. Participants felt that although MOUD in primary care would improve access and reduce stigma for patients, prescribing requires improved provider education and an integrated system of care. Conclusions The results of this study provide an argument for tailoring education to specifically address the barriers primary care prescribers perceive. Results promote the utilization of active, hands-on learning approaches, to ultimately promote uptake of MOUD prescribing in the primary care setting in South Carolina.

“You’re Not Supposed to be on it Forever”: Medications to Treat Opioid Use Disorder (MOUD) Related Stigma Among Drug Treatment Providers and People who Use Opioids

“…11,17,18 Many providers also echo the belief that MOUD is "just another drug." 19,20 Further, primary care physicians expressed concern that providing buprenorphine would "open the floodgates" to people with OUD, who were "difficult patients" and likely to be non-adherent or divert medications to non-prescribed uses or the street economy. 19 Research has suggested that exaggerated and unfounded fears of diversion have negatively affected office-based buprenorphine treatment.…”

“…For example, research has shown that many people with OUDs are opposed to starting MOUD, feeling that it is “just another drug” or “replacing one drug for another,” an opinion echoed by many in the public and in 12-step groups. 11 , 17 , 18 Many providers also echo the belief that MOUD is “just another drug.” 19 , 20 Further, primary care physicians expressed concern that providing buprenorphine would “open the floodgates” to people with OUD, who were “difficult patients” and likely to be non-adherent or divert medications to non-prescribed uses or the street economy. 19 Research has suggested that exaggerated and unfounded fears of diversion have negatively affected office-based buprenorphine treatment.…”

Buprenorphine Waiver Attitudes Among Primary Care Providers

“…14,15 Provider concerns about "opening the flood gates" to OUD patients and beliefs about the usefulness of MOUD have also been identified as barriers. 12,[16][17][18] Multiple studies have reported stigma among healthcare providers against patients struggling with substance use disorder, which accounts for the hesitancy in prescribing MOUD. [19][20][21][22] It is unclear if the recent removal of the buprenorphine waiver training requirement has changed attitudes toward some of these perceived barriers, especially among primary care providers who are at the forefront of the opioid epidemic.…”

The Role of Context in Integrating Buprenorphine into a Drop-In Center in Kampala, Uganda, Using the Consolidated Framework for Implementation Research

“…(While Medications to treat Opioid Use Disorder, MOUD, are now the preferred nomenclature for this class of treatment, MAT is still the most commonly used term in Uganda, so we will use MAT throughout the paper to avoid confusion.) However, even though both methadone and buprenorphine have been used for many decades in many countries such as the US, there is still a considerable amount of stigma regarding MOUD, which is amplified by tight regulations over its use [ 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. Tanzania and Kenya recently opened methadone clinics in 2016 and 2018, respectively [ 37 , 38 ].…”