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Primary Care Physicians' Views about Prescribing Methadone to Treat Opioid Use Disorder.

Abstract：

BACKGROUND:Methadone maintenance treatment is an effective way to reduce harms associated with opioid use disorder and, in several countries, is delivered in community-based primary care settings. Expanding methadone into primary care depends, in part, on physicians' willingness and readiness to integrate it into their practices. OBJECTIVES:This qualitative study explores factors that primary care physicians consider important when contemplating prescribing methadone to treat opioid use disorder. METHODS:In-depth interviews were conducted during 2015 with 20 primary care physicians in various sized communities throughout Nova Scotia, Canada. Participants shared their views and experiences related to prescribing methadone to treat opioid use disorder. Data were analyzed inductively using thematic analysis to identify predominant themes. RESULTS:Participants discussed an interplay of factors as they contemplated prescribing methadone to treat opioid use disorder in primary care. Physician-related factors included access to methadone expertise, support from allied professionals, suitability of skills, and personal experiences. Patient-related factors involved perceptions about methadone users as a difficult patient group with highly complex needs. Practice-related factors encompassed concerns about threats to physicians' careers, surveillance duties, unfair remuneration, safety risks, and practice disruptions. Contextual factors included knowledge deficits about substance use disorders, the generalist nature of primary care, methadone's socio-political context, and opioid prescribing patterns in primary care. CONCLUSIONS:Understanding the perspectives of physicians is vital to expanding methadone into primary care. This study identifies factors that should be addressed to attract, support, and retain primary care physicians in prescribing methadone to treat opioid use disorder.

journal_name

Subst Use Misuse

journal_title

Substance use & misuse

authors

Livingston JD,Adams E,Jordan M,MacMillan Z,Hering R

doi

10.1080/10826084.2017.1325376

subject

Has Abstract

pub_date

2018-01-28 00:00:00

pages

344-353

issue

eissn

1082-6084

issn

1532-2491

journal_volume

pub_type

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Primary Care Physicians' Views about Prescribing Methadone to Treat Opioid Use Disorder.