Perceived barriers toward the provision of opioid replacement therapy in primary care: a literature review
Loading...
Date
2020
Authors
Barnabé, Kylee
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Introduction: According to the Manitoba Centre for Health Policy, 5.9% of Manitobans were diagnosed with a substance use disorder (SUD) between 2010 and 2015. For patients with opioid use disorder (OUD), opioid replacement therapy (ORT) in combination with psychotherapy is the first line treatment. However, many primary care physicians choose not to provide this service and
identify a variety of barriers to the provision of ORT. As a result, individuals with OUD are left without access to treatment.
Objective: The objective of this study is to identify and explore physician sentiments and
perceived barriers to the provision of ORT therapy for the treatment of OUD. Ultimately, this study aims to provide rationale for primary care providers to appreciate the value in providing ORT, and to encourage them to offer ORT to their patients with OUD.
Methods: A literature search was performed using the PubMed database with search terms “opioid replacement therapy”, “opioid agonist therapy”, “provider barriers”, “ORT”, and “opioid use disorder in primary care.” The search yielded a total of 1,679 articles, with 6 articles deemed appropriate for inclusion in the study.
Results: The most commonly cited barrier was the lack of access to psychosocial supports and specialty backups for physicians providing ORT. Other commonly identified barriers and perceptions included generalized mistrust of patients with OUD and their potential to divert medications, difficult patient population and potential for patientsto negatively affect a physician’s practice, the high degree of regulation and potential for legal consequences, lack of fair remuneration for services provided, logistic barriers such as increased administrative duties, lack of physician’s confidence and formal education regarding substance use disorders, as well as the generalized stigma surrounding opioid use and ORT.
Conclusion: ORT using Methadone and Buprenorphine/Naloxone has consistently been shown to have positive results in the context of reducing substance use, mortality rates, and adverse health outcomes while improving psychosocial functioning and quality of life. A significant number of barriers to the provision of ORT may be addressed and resolved with fair remuneration, increased education, and increased access to programming and services. Effective and accessible access to the treatment of opioid use disorder continues to be an uphill battle, necessitating greater partnership between government planning and resources, along with physician willingness to adapt their practice accordingly.
Description
Keywords
opioid