New Study Reveals Reasons Behind Doctors’ Hesitation in Prescribing Addiction Treatments

Recently, a comprehensive study led and funded by the National Institute on Drug Abuse (NIDA) and published in JAMA Network Open has shed light on the top reasons behind the reluctance of physicians to intervene in cases of addiction.

Key Barriers to Physician Intervention

The study, which reviewed 283 studies spanning 61 years, identified the “institutional environment” as the most frequently cited barrier to physician intervention in addiction. This encompasses a lack of support from institutions or employers, insufficient resources, challenges within organizational culture, and competing demands. It was highlighted in 81% of the studies reviewed. Insufficient skill (74%), lack of cognitive capacity to manage a certain level of care (74%), and inadequate knowledge (72%) were also prominent reasons for physicians’ reluctance. These findings point to a critical need for enhanced education and training programs to equip physicians with the necessary skills and knowledge to effectively manage addiction cases.

Social and Relationship Concerns

Negative social influences and concerns about public and community acceptance of addiction care were cited in 66% of the studies, while 56% of studies mentioned fear of harming the patient-physician relationship. These factors likely reflect the pervasive stigma associated with substance use disorders.

Reimbursement Concerns

Reimbursement concerns for addiction interventions were another significant deterrent. Financial incentives and adequate reimbursement for addiction treatment are crucial to ensuring that physicians are willing and able to provide the necessary care. The study’s findings emphasize the need for institution-wide changes to support the adoption of evidence-based substance use disorder treatment practices among physicians. Increasing organizational support, leadership and staff buy-in, and comprehensive education and training are essential steps in this direction.

The Need for Comprehensive Care

Dr. Nora D. Volkow, Director of NIDA, aptly stated, “People with substance use disorders must be able to access compassionate and evidence-based care at any touchpoint they have with a healthcare provider.” This vision requires that clinicians across all medical disciplines receive greater training, resources, and support in caring for people with addiction.

Current Treatment Landscape

Despite the availability of effective interventions for treating substance use disorders, including medications and behavioral therapies, the adoption of these practices remains low, and demand for treatment exceeds capacity. In 2022, nearly 49 million people in the U.S. had at least one substance use disorder, yet only around 13 million received treatment. For opioid use disorder specifically, more than 9 million adults needed treatment, but fewer than half received any form of treatment, and only 25% received medications for opioid use disorder.

Study Insights and Recommendations

The study reviewed barriers to adopting evidence-based practices for addiction, with data from 66,732 physicians primarily in general practice, internal medicine, and family medicine. Alcohol, nicotine, and opioids were the most often studied substances, and screening and treatment were the most often studied interventions.

Facilitating Physician Intervention

The researchers also identified factors that facilitate physician intervention in addiction, including community outreach efforts, educational materials for patients and families, and public health campaigns promoting non-stigmatizing language. These findings suggest that multifaceted approaches are necessary to encourage more widespread adoption of addiction treatment practices.

However, the study also highlighted the need for high-quality studies that address limitations such as inconsistent terminology and reporting. Developing rigorous, standardized survey methodologies is crucial for advancing our understanding of the barriers and facilitators to addiction treatment.

Moving Forward

NIDA Deputy Director Dr. Wilson M. Compton emphasized the importance of studying the implementation of new addiction treatments to ensure they reach the people who need them. He stated, “Survey results have helped us better understand the treatment landscape, so the next step is to test ways to change behavior and attitudes around providing addiction treatment, in order to break down barriers to the addiction care that people seek.”

As treatment practices continue to evolve, future studies should closely examine the role of stigma in limiting treatment implementation. It is also important to consider the unintended impacts of increased physician intervention, such as potential strain on the physician-patient relationship, the possibility of neglecting other healthcare needs due to a focus on addiction, and the risk of stigmatizing interactions with other healthcare providers.

The comprehensive review conducted by NIDA illuminates the multifaceted challenges that physicians face when it comes to intervening in addiction cases. The predominant barrier, the “institutional environment,” highlights a systemic issue that requires institution-wide reforms. To create an environment where physicians feel equipped and supported to tackle substance use disorders, there must be a concerted effort to provide sufficient resources, foster a supportive organizational culture, and address competing demands effectively.