Why Aren't More Doctors Embracing Medication-Assisted Treatment?

By Paul Gaita 04/03/19

A new op-ed suggests that concerns about "branding" may deter many doctors from offering medication-assisted treatment (MAT) for opioid use disorder.

doctors discussing medication-assisted treatment

A new op-ed on STAT News highlights a troubling concern in regard to medication-assisted treatment (MAT).

Author David A. Patterson Silver Wolf, PhD, opined that the reason why methadone, buprenorphine and naltrexone aren't more widely used to treat opioid use disorders (OUDs) may be due to "branding"—specifically, concern on the part of primary care physicians about the stigma associated with OUDs and its effect on their practice.

But as Silver Wolf noted, the toll taken by the opioid epidemic on individuals and families all but required physicians to undertake the necessary steps to prescribe MAT, despite any qualms they may have.

In the article, Silver Wolf, an associate professor at Washington University in St. Louis, Missouri and faculty member for training programs funded by the National Institute on Drug Abuse (NIDA), wrote that he came to his opinion after participating in a national panel of addiction experts that produced "Medications for Opioid Use Disorder Save Lives," a report from the National Academies of Sciences, Engineering and Medicine.

In the report, he and his fellow experts noted that while the need for medication-assisted treatment is sizable, and drugs like methadone and Suboxone have been approved as safe and effective treatments for OUD by the Food and Drug Administration (FDA), only a small number of physicians have signed up for the necessary training by the Drug Enforcement Administration (DEA) to be able to prescribe it.

Silver Wolf also cited another STAT opinion piece, which speculated on some of the reasons why more physicians haven't been lining up to prescribe MAT. One deterrent may be the process for receiving a federal waiver and the specialized training required to administer this treatment.

But he also suggested that concern over the perception of those with substance use disorders by other patients may also color certain medical professionals' opinions, who fear that the inclusion of such individuals to a patient base may negatively impact business.

"Physicians whose practices focus on patients with opioid use disorder don't have to worry about their 'brand' being harmed because it is tied to this treatment and this patient population," Silver Wolf wrote. "But a typical primary care physician in Manhattan or suburban Atlanta or rural Nevada might worry about the potential trouble that patients with addictions might cause in their waiting rooms." 

The answer, according to Silver Wolf, is for more physicians to look past financial concerns and stigma, and take the steps to make medication-assisted treatment a part of their practice—even though, he adds, that many will not.

But if individuals and families impacted by the addiction crisis—what the National Academies committee has come to view as an "all-hands-on-deck" situation—then Silver Wolf believes that physicians need to do the same.

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, Amazon.com and The Los Angeles Beat, among many other publications and websites.