As policymakers struggle to reverse the opioid addiction crisis, researchers contend that a promising way to address the issue, especially in rural areas, would be to train more family physicians to prescribe buprenorphine.
Although more than one-third of physicians who have completed the training required under the Drug Addiction Treatment Act and are certified to prescribe buprenorphine are psychiatrists, only 5.5 percent of these psychiatrists practice in rural areas, according to research by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care. In contrast, family physicians comprise less than 20 percent of physicians who are approved to prescribe buprenorphine, but the proportion of these approved family physicians who work in rural areas (15.4 percent) is closely aligned with the percentage of Americans who live in these areas (17.6 percent).
The research was published in an article titled "Rural Opioid Use Disorder Treatment Depends on Family Physicians" in the Oct. 1 issue of American Family Physician. The authors tracked the number of physicians by specialty who can prescribe buprenorphine, using data from the AMA's Physician Masterfile and the DEA's list of approved prescribers.
Opioid addiction and misuse contributed to 28,647 deaths in 2014, and the problem is the focus of widespread attention on Capitol Hill and in the media. The distribution of physicians in rural areas points to family physicians as having an essential role in the solution.
"More than any other specialty, increasing the number of approved FPs, particularly through expanding buprenorphine training in residency programs, would help to rectify the relative shortage of physicians approved to prescribe buprenorphine in rural areas," the researchers wrote.
Although working with a patient who is struggling with addiction can be especially rewarding, doing so in rural areas is much more challenging, one family physician told AAFP News.
"There is no difference in how the disease affects rural patients, but there are limited treatment options," said Jacob "Gus" Crothers, M.D., a former Graham Center scholar who practices primary care and addiction medicine in New Haven, Conn. "It is not realistic to expect a rural patient to travel one hour or more to receive treatment on an ongoing basis."
Crothers, who also is medical director of clinical personnel for the health care technology company Grand Rounds, has researched opioid addiction and developed training and education materials for treatment.
"The treatments work," Crothers said. "The patients get better. They make a dramatic improvement, and you get to see early results quickly. As you stay with the patients long term, you see them put their lives back together."
He noted that a physician's role includes providing medication as well as emotional support because addiction patients can relapse just as a diabetes patient might. A physician also needs to educate patients and correct any false assumptions they have about treatment. For instance, Crothers said many patients believe medication-assisted treatment for opioid addiction is simply replacing one addiction with another, or that treatment is only a matter of willpower.
"If they think that, then they are unlikely to be successful," he said.
Crothers thinks the brighter spotlight on opioid misuse and addiction has helped start a policy discussion, but more state and federal support is needed.
"A lot of attention is being paid to reducing opioid prescriptions, and that is a good step, but it is not enough," he said. "There needs to be an increased emphasis on providing more treatment resources in urban and rural areas.
"We also need more research on effective pain treatments that do not involve narcotics."
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