One-third of primary care physicians do not support the use of medications for treating opioid use disorders

Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.

1. One-third of primary care physicians do not support the use of medications for treating opioid use disorder

Abstract: http://annals.org/aim/article/doi/10.7326/M19-3975

URL goes live when the embargo lifts

A survey of primary care physicians found that one-third did not perceive medications to treat opioid use disorder (OUD) to be more effective than nonmedication treatment or safe for long-term use, despite conclusive evidence to the contrary. Physicians also reported low interest in treating OUD and low support for policy proposals allowing office-based physicians to prescribe buprenorphine and methadone. These findings are reported in a brief research report published in Annals of Internal Medicine.

Researchers from Johns Hopkins Bloomberg School of Public Health and Johns Hopkins Center for Mental Health and Addiction Policy Research surveyed a random sample of 1,000 licensed physicians selected from a large U.S. database to find out their thoughts and attitudes about medications for OUD. Of 336 respondents, one fifth expressed interest in treating patients with OUD. Most of the physicians surveyed perceived buprenorphine as more effective than methadone or naltrexone, but very few reported prescribing these medications or obtaining a buprenorphine waiver. More than 81 percent of respondents supported increasing insurance coverage of government investment in OUD medication, but fewer than half supported allowing physicians to prescribe methadone for OUD in primary care settings or eliminating the buprenorphine waiver requirement.

According to the researchers, these findings suggest that policy changes alone are unlikely to lead to widespread availability of primary care-based medication. They urge efforts to increase primary care physicians' acceptance of and willingness to prescribe medications for OUD.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the lead author, Emma E. McGinty, PhD, MS, please contact Caitlyn Hoffman at choffman@jhu.edu.

2. Special series aims to help clinicians improve their decision-making skills

Abstract: http://annals.org/aim/article/doi/10.7326/M20-1423

URL goes live when the embargo lifts

A series of concise articles titled "Clinical Decision Making" aims to help clinicians in all stages of their careers hone vital decision-making skills. Published together in Annals of Internal Medicine, the articles use examples to pose and answer questions about the crucial concepts and foundational science that are essential to informing the decisions clinicians must make in everyday medical practice.

The series is organized by two practicing clinicians and experienced educators from Massachusetts General Hospital. Joshua P. Metlay, MD, PhD, and Katrina A. Armstrong, MD, MS, present lessons in a straightforward manner so that clinicians may walk away from reading the series with a clear understanding of how to how to evaluate evidence, assess its limitations, and apply it to individual patients, among other important aspects of making clinical decisions. Topics covered in the series include:

• "Weighing Evidence to Inform Clinical Decisions" explains how to sort through new evidence and decide when to incorporate it into practice.

• "Using a Diagnostic Test" provides pragmatic advice about how to make appropriate diagnostic choices and interpret the results rationally.

• "Translating Population Evidence to Individual Patients" focuses on applying what is learned from studies of many patients to the treatment of the individual patient.

• "Communicating Risk and Engaging Patients in Shared Decision Making" answers important questions about when and how to involve patients in clinical decision making.

• "Incorporating Perspective Into Clinical Decisions" discusses how to balance caring for the individual patient with obligations to payers, regulators, hospitals, public health agencies, and broader societal needs.

• "Avoiding Cognitive Errors in Clinical Decision Making" gives physicians practical advice on how to slow down and avoid common practices and pitfalls that may lead to clinical mistakes.

The series is punctuated with the graphic narrative "Bed Blocker" that literally illustrates some of the key lessons outlined in the series. The comic describes a near miss that might have had catastrophic consequences if diagnostic errors had gone unchecked and highlights the lessons to be gleaned from such a situation.

Media contacts: For an embargoed PDF please contact Lauren Evans at laevans@acponline.org. To speak with the series organizers, please contact Rosemary Kielnecker at RKIELNECKER@mgh.harvard.edu.

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