Abstract
This survey study assesses the US public’s perception and awareness regarding medication for opioid use disorder and its availability in primary care settings.
Introduction
Primary care physicians (PCPs), a frequent, convenient, nonstigmatized touchpoint with health care, hold promise for expanding access to buprenorphine, the only office-based medication for opioid use disorder (MOUD) with demonstrated effectiveness in reducing overdose mortality.1 To expand buprenorphine-based treatment, federal policy has eliminated specialized training requirements for prescribing physicians and lifted patient caps. A wide gap remains, however, between buprenorphine need and provision in primary care settings.2
Research has explored barriers and facilitators of MOUD from physicians’ perspectives.3 While evidence suggests patients may respond favorably to MOUD in primary care settings,4,5 we know little of their awareness that MOUD can be prescribed there or opinion of whether PCPs ought to provide MOUD, whether patients would seek it, and whether they would refer someone to their PCP to obtain it. This survey study explored these questions.
Methods
Data were obtained from a June 2023 cross-sectional survey for the Justice Community Opioid Innovation Network. The survey was administered in English and Spanish and offered online and by telephone to a probability-based, nationally representative sample of adults 18 years or older drawn from the National Opinion Research Center’s (NORC) AmeriSpeak panel. The NORC Institutional Review Board deemed this study exempt from review. Consent was obtained orally from telephone participants and electronically from online participants. We followed the AAPOR reporting guideline.
Analyses were performed with Stata 15.0 (StataCorp). Weighted Pearson χ2 tests and ad hoc regression were used, with prespecified 2-tailed significance of P < .05. Survey items and weighting methods are presented in the eAppendix in Supplement 1. Race and ethnicity data were collected to examine the relevant demographic differences in participant responses.
Results
A total of 1234 individuals responded (700 females [56.5%], 539 males [43.5%]; 11.5% identifying as Black, 15.2% as Hispanic or Latino, 68.4% as White, and 4.8% as other or with ≥2 race and ethnicity; ages were reported categorically to protect confidentiality) (Table 1). Most respondents either did not know a PCP could treat people with an opioid use disorder (OUD) by prescribing MOUD (61.4% weighted) or incorrectly believed a PCP could not (13.3% weighted). Most respondents agreed (658 [53.9%]) or strongly agreed (309 [24.9%]) that a PCP office should be a place where people can receive OUD treatment (Table 2).
Table 1. Association of Demographic Characteristics With Knowledge and Beliefs About MOUD and OUD Treatment in Primary Care Settings.
| Survey item | Participants, No. (unweighted %) | Weighted % | To the best of your knowledge, can PCPs treat people with an OUD by prescribing them a medication for their disorder? (n = 1234) | The office of a PCP should be a place where people can receive OUD treatment (n = 1221) | |||||
|---|---|---|---|---|---|---|---|---|---|
| Yes, weighted % | No, weighted % | Do not know, weighted % | P value | Disagree, weighted % | Agree, weighted % | P value | |||
| Totala | 1234 (100.0) | 100.0 | 25.3 | 13.3 | 61.4 | NA | 23.8 | 76.2 | NA |
| Age, yb | |||||||||
| 18-29 | 196 (16.1) | 19.7 | 18.4 | 23.8 | 57.8 | .002 | 19.1 | 80.9 | .03 |
| 30-44 | 354 (29.0) | 25.8 | 28.3 | 10.7 | 60.9 | 17.1 | 82.9 | ||
| 45-59 | 261 (21.4) | 23.8 | 23.7 | 13.0 | 63.3 | 28.3 | 71.8 | ||
| ≥60 | 410 (33.6) | 30.7 | 29.3 | 8.7 | 62.0 | 26.6 | 73.4 | ||
| Genderc | |||||||||
| Male | 539 (43.5) | 49.1 | 29.1 | 12.7 | 58.2 | .10 | 22.1 | 77.9 | .54 |
| Female | 700 (56.5) | 50.9 | 22.1 | 13.8 | 64.1 | 24.0 | 76.0 | ||
| Race and ethnicityd | |||||||||
| Black | 143 (11.5) | 12.0 | 27.5 | 19.5 | 53.1 | .05 | 20.9 | 79.1 | .62 |
| Hispanic or Latino | 188 (15.2) | 17.3 | 18.8 | 19.3 | 62.0 | 26.4 | 73.6 | ||
| White | 848 (68.4) | 61.6 | 26.6 | 9.7 | 63.7 | 21.9 | 78.1 | ||
| Other or ≥2 racese | 60 (4.8) | 9.1 | 28.4 | 17.6 | 54.0 | 27.4 | 72.6 | ||
| Political party affiliation | |||||||||
| Democrat | 429 (34.9) | 33.1 | 25.5 | 16.2 | 58.3 | .59 | 19.8 | 80.2 | .03 |
| Lean Democrat | 146 (11.9) | 10.6 | 27.3 | 10.2 | 62.5 | 13.3 | 86.7 | ||
| Lean Independent or none | 217 (17.7) | 19.2 | 25.3 | 11.6 | 63.0 | 30.2 | 69.8 | ||
| Lean Republican | 112 (9.1) | 9.7 | 17.6 | 13.9 | 68.5 | 25.8 | 74.2 | ||
| Republican | 325 (26.4) | 27.4 | 27.4 | 12.0 | 60.6 | 25.5 | 74.5 | ||
| Educational level | |||||||||
| Less than high school | 62 (5.0) | 8.8 | 23.7 | 16.8 | 59.6 | .26 | 25.1 | 74.9 | .84 |
| High school diploma or equivalency | 231 (18.6) | 29.1 | 24.3 | 15.9 | 59.7 | 20.1 | 79.9 | ||
| Some college or associate’s degree | 533 (43.0) | 26.4 | 25.8 | 10.5 | 63.7 | 24.2 | 75.8 | ||
| Bachelor’s degree | 246 (19.9) | 22.4 | 21.7 | 14.4 | 64.0 | 24.4 | 75.6 | ||
| Postgraduate study or professional degree | 167 (13.5) | 13.4 | 35.4 | 8.5 | 56.1 | 23.7 | 76.4 | ||
Abbreviations: MOUD, medications for opioid use disorder; NA, not applicable; OUD, opioid use disorder; PCP, primary care physicians.
In cases where a respondent skipped a question online, it was coded as missing and analyzed using complete case analysis.
Age was recorded categorically in the dataset used for analysis to protect the confidentiality of respondents.
Gender was classified as a binary for these analyses to protect the identity of nonbinary respondents, whose individual cell values were fewer than 10.
Race and ethnicity were self-identified by survey participants.
Other is defined here as self-identified race not displayed in the table, such as Asian and American Indian or Alaska Native.
Table 2. Knowledge, Attitudes, and Beliefs About Medications for Opioid Use Disorder in the Primary Care Setting Among a Nationally Representative Sample of US Adultsa .
| Survey item | Participants, No. (unweighted %) | Weighted % |
|---|---|---|
| Respondent has a PCP (n = 1232)b | ||
| Yes | 1038 (84.3) | 84.8 |
| No | 194 (15.8) | 15.2 |
| If yes, visited PCP in past 12 mos (n = 1037)c | ||
| Yes | 889 (85.7) | 85.1 |
| No | 148 (14.3) | 14.9 |
| Can PCPs treat a patient using MOUD? (n = 1234)b | ||
| Yes | 327 (26.5) | 25.3 |
| No | 146 (11.8) | 13.3 |
| I don’t know | 761 (61.7) | 61.4 |
| PCPs should treat OUD in their offices (n = 1221)b | ||
| Strongly agree | 304 (24.9) | 24.2 |
| Agree | 658 (53.9) | 52.8 |
| Disagree | 212 (17.4) | 19.0 |
| Strongly disagree | 47 (3.9) | 4.1 |
| Comfort of respondents with any history of opioid misuse personally seeking MOUD from their PCP (n = 266) d , e | ||
| Very comfortable | 127 (47.7) | 50.6 |
| Somewhat comfortable | 89 (33.5) | 30.7 |
| Somewhat uncomfortable | 28 (10.5) | 10.5 |
| Very uncomfortable | 22 (8.3) | 8.3 |
| Comfort of respondents with no history of opioid misuse referring others to their PCP for MOUD (n = 945) e , f | ||
| Very comfortable | 316 (33.4) | 31.9 |
| Somewhat comfortable | 388 (41.1) | 42.0 |
| Somewhat uncomfortable | 168 (17.8) | 18.5 |
| Very uncomfortable | 73 (7.7) | 7.7 |
Abbreviations: MOUD, medications for opioid use disorder; OUD, opioid use disorder; PCP, primary care physicians.
Data were collected from a June 2023 probability-based, nationally representative online and telephone survey of 1234 US adults at least 18 years of age conducted by the National Opinion Research Center at the University of Chicago. Respondents who skipped questions online had that response coded as missing. The precise wording of items and the instrument’s definitions, skip logic, and branch logic are presented in the eAppendix in Supplement 1.
All respondents received this item.
Only respondents who reported having a PCP received this item.
Only respondents who reported prior misuse of opioids received this item.
If a patient reported not having a PCP, they were asked to think of the last physician they visited for a routine checkup.
Only respondents who never reported prior misuse of opioids received this item.
Among respondents who reported ever misusing prescription or illicit opioids, 50.6% (weighted) said they would be very comfortable and 30.7% (weighted) would be somewhat comfortable personally seeking MOUD from their PCP. Of the respondents with no history of opioid misuse, 31.9% (weighted) said they would be very comfortable and 42.0% (weighted) would be somewhat comfortable referring someone they cared about to their PCP for MOUD (Table 2). In aggregate, Black respondents (20.9% weighted) were most likely to believe they could not receive MOUD at a PCP (Table 1).
Discussion
The findings suggest most respondents did not know a PCP can provide MOUD. Raising awareness that PCPs can is critical to increasing effective treatment of OUD and reducing the race-and-ethnicity–based disparities in knowledge about MOUD access observed in this study. Interventions could include messaging campaigns similar to those for HIV testing and cancer screening. Literature and signage about MOUD could be placed in waiting areas and examination rooms. PCPs could proactively screen patients for OUD and offer to prescribe MOUD as indicated. Measures to raise awareness about the opportunity to receive MOUD from PCPs may increase demand and incentivize PCPs to offer MOUD, especially if accompanied by clinical and administrative support, such as access to addiction medicine consultations.6
Limitations are inherent in probability-based weighted samples and respondents’ understanding of MOUD. However, our methods found the approximately 209 000 PCPs in the US positioned to play a decisive role in expanding access to buprenorphine. Increasing the public’s knowledge of this potential may help convert it to action.
eAppendix.
Data Sharing Statement
References
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
eAppendix.
Data Sharing Statement