Medications to treat opioid use disorder have proven to be really effective: They can reduce cravings and withdrawal symptoms, decrease the risk of overdose and help slow the spread of infectious diseases.
But primary care providers across Ohio are hesitant to prescribe them.
“The fact that we even have these [medications] available is a wonderful miracle of science,” said Berkeley Franz, a professor of community-based health at Ohio University. “But what's really troubling to me as a scientist is that, despite these being really effective, we don't really implement them.”
One study from 2023 suggests only one in five people with opioid addiction in the U.S. received medication to treat it.
“And so that tells me that we're not providing them in the most convenient settings or the right places,” Franz said.
She’s leading an effort to expand access to medications for opioid use disorder in primary care settings. With a $4 million grant from the National Institutes of Health, her team is building a mentorship network across Ohio and West Virginia to connect clinicians comfortable prescribing these medications with those newer to the practice.
“Addiction is just another type of medical care that people need and it shouldn't be siloed or segregated,” she said. “And so I'm hopeful this model will help integrate it successfully.”
Fear, stigma and training barriers
Of the country’s primary care providers authorized to prescribe medication for opioid use disorder, Franz says only about 8% do so. Many refer patients to specialists or abstinence-focused programs instead.
Franz says there are several reasons for this hesitancy. Southeast Ohio, specifically, suffered a disproportionate amount of overdoses as a result of the opioid epidemic. Some medications used to treat opioid addiction, like methadone and buprenorphine, are opioid agonists or partial agonists — designed to bind to opioid receptors in the brain — and that gives some providers pause.
“Addiction is just another type of medical care that people need and it shouldn't be siloed or segregated.”Berkeley Franz
“I think a lot of people are scared of prescribing opioids in general,” Franz said. “They've seen the harm that they can cause. They also have seen the over side of opioid prescribing and fear getting in trouble for prescribing them.”
Additionally, she says providers face training barriers: Medical and nursing schools have limited time to devote to substance use treatment.
And there’s still stigma around these medications.
“I think there's still a question of like, what role does medication play and does it really constitute recovery?” Franz said.
A mentorship model
Franz’s team has spent years studying this hesitancy. They’ve surveyed hundreds of primary care providers across Ohio to learn more about the challenges they face. And they’ve developed an online program to address clinical skills and tackle misinformation about medications for opioid use disorder.
Now, they’re taking this work a step further.
“What we decided is that we really needed a mentorship program where people can check in with people who are also doing this work in primary care settings,” Franz said.
It’s meant to give clinicians extra support as they begin prescribing medications like methadone and buprenorphine.
Franz says it’s important these medications are available in primary care environments.
“It's less stigmatizing. Patients can go in for any other medical care and have it all done in the same place,” she said. “And I think my hope is that we'll have a model of training that makes this medication a lot more available to people who can benefit from it.”
