Primary care practices need to offer better access to medication-assisted treatment for people addicted to opioids, according to a series of papers published in the New England Journal of Medicine.
Not enough doctors offer buprenorphine, a drug that can treat pain as well as addiction, and are barred from prescribing methadone, another opioid-based use for addiction treatment. With nearly 80% of Americans with opioid use disorder not receiving treatment, one answer is for physicians and policymakers to do more to make medication-assisted treatment available in primary care settings, the authors said.
Here are their ideas:
More primary care providers can offer buprenorphine
Two Boston doctors, Sarah E. Wakeman, M.D., of Massachusetts General Hospital, and Michael L. Barnett, M.D., of Brigham and Women’s Hospital, wrote about the suggestion in one paper.
“We believe there’s a realistic, scalable solution for reaching the millions of Americans with opioid use disorder: mobilizing the primary care physician (PCP) workforce to offer office-based addiction treatment with buprenorphine, as other countries have done,” they wrote, adding that “few other evidence-based actions would have such an immediate lifesaving effect.”
Expand access to methadone
In a second paper, three authors wrote that methadone should be available in primary care offices, not just designated clinics. Although it is one of the oldest and most-effective medications to treat opioid addiction, methadone is not approved in primary care settings in the U.S. It is available for prescription in primary care clinics in Great Britain, Canada and Australia.
“We believe the time has come to update laws that regulate the prescription of methadone in primary care in order to reduce barriers to access and extend the benefits of a proven, effective medication to people throughout the country,” the authors wrote.
Expanding access to methadone in primary care will require both legislation and enhanced training for physicians, incentives for prescribing medications and the integration of treatment into existing models of care, they added.
Improve the quality of buprenorphine treatment
In a third article, three authors argued that the health care system can do a better job treating patients with the medication. “The larger goal is reorienting care from simple medication prescribing to a wider focus on patients’ long-term recovery needs,” they write.
Community clinicians treating opioid use disorders can gain support with partnerships between office-based providers and specialty program and recovery supports, they said.
In a step aimed at combating the nation’s opioid epidemic, the Drug Enforcement Administration took action earlier this year to allow nurse practitioners and physician assistants to prescribe and dispense buprenorphine.