Current Management of Opioid Use Disorder and Barriers to Prescribing Opioid Agonist Therapy by Primary Care Providers in the Interlake-Eastern Health Region

Abstract

Background: Opioid agonist therapy (OAT) is the first-line treatment for opioid use disorder. It has traditionally been provided through specialized addictions clinics, but more recently, there has been a push for primary care providers (PCPs) to take on this service. This has been met with reluctance by providers who cite a lack of adequate time, knowledge, and remuneration, among other barriers. Objective: The primary objective of this study was to explore provider-reported attitudes on and barriers to integrating OAT into primary care, specifically within the Interlake-Eastern Health Region (IERHA). The aim was to improve regional access by generating actionable recommendations to address these barriers. A secondary objective was to explore how PCPs currently manage opioid use disorder. Methods: This study employed a quality improvement design. Participants were purposively sampled from PCPs in the IERHA who did not have licensure to prescribe OAT. Structured individual interviews were conducted from May to June 2022. Transcripts were analyzed for overarching themes as they related to the study objectives. Results: Fourteen participants were included in the study. Fee-for-service providers were largely unwilling to prescribe OAT in the primary care setting and cited a multitude of factors for this such as lack of adequate remuneration, time, and perceived need. Notably, many providers were frustrated with the limited nature of mental health resources and expressed a sense of futility in providing OAT without these supports. Conclusion: Overall, fee-for-service providers in the IERHA expressed a myriad of barriers with respect to their unwillingness to prescribe OAT. At present, priority should be placed on contracted providers in expanding primary care access. Fee-for-service providers would be best utilized for maintenance prescriptions or OAT induction in a small number of less complex patients.