Training Improves Generalist Physicians’ Confidence in Treating Opiate Misuse

Training is a common component of initiatives that advocate greater involvement of generalist physicians (GPs) in treating opiate use disorders. British researchers measured the effectiveness of training GPs to change knowledge, attitudes, and clinical practices around opiate disorders.

Sixty-three GPs were randomized to a 6-month training certificate course; 49 were randomized to a waiting list control (20 of whom bypassed the waiting list and completed the course by paying for it themselves). All GPs were interviewed at study enrollment and 6 months later. Intent-to-treat analyses* suggested the following:

• Both groups showed similar improvements in knowledge.
• The proportion who were “very confident” in prescribing methadone for maintenance increased significantly in both groups, but moreso in the intervention group (from 33% to 72% versus 31% to 55% for the controls).
• The proportions who saw patients who misused opiates (about 90% in both groups at enrollment) and prescribed methadone to these patients did not significantly change in either group.  However, these behaviors increased in the intervention group but decreased in controls.

Results were similar in analyses that compared subjects who received training (including those who bypassed the waiting list) with subjects who did not receive training, though the former had significantly greater improvements in knowledge.

Comments:

Even though the level of interest in treating drug use was high and subject to ceiling effects and the control group was contaminated with GPs who paid for their own training, this rigorous study still found positive effects of training on physicians’ confidence.  Abundant theoretical and empirical work suggests that such confidence is key to physicians’ involvement in the care of substance use disorders. These findings are reassuring in light of the ongoing training initiative to promote the dissemination of office-based buprenorphine maintenance in the U.S.

Peter D. Friedmann, MD, MPH

Reference:

Strang J, Hunt C, Gerada C, et al. What difference does training make? A randomized trial with waiting-list control of general practitioners seeking advanced training in drug misuse. Addiction. 2007;102(10):1637–1647.