In a US Cohort of People With Injection Drug Use, Primary Care Engagement Was Not Associated With Initiation or Continuation of Medications for Opioid Use Disorder

In the US, a small fraction of adults with opioid use disorder (OUD) receive effective medications for OUD (MOUD). Primary care clinicians can help facilitate initiation of MOUD by prescribing buprenorphine. Researchers used 2014–2020 data from a prospective cohort of individuals with injection drug use in Baltimore, Maryland to investigate the association of engagement in primary care with initiation and continuation of MOUD.* They included as index visits all visits where a participant reported: a) any past 6-month opioid use non-medically; and b) no use of MOUD in the past 6 months.

• There were 360 individuals and 789 study visits included in the analysis; at 490 index visits (62 percent) participants reported primary care engagement. At follow up visits, 17 percent had initiated methadone and 10 percent initiated buprenorphine.
• In adjusted analysis, there was no significant association between engagement in primary care and initiation or continuation of MOUD, including buprenorphine.

* This study assessed initiation and continuation of buprenorphine or methadone; in the US, methadone cannot be prescribed in primary care. 

Comments: It is disappointing to see that primary care clinicians have not stepped up to address an important medical problem that affects their patients and for which there is a very effective treatment. Offering buprenorphine for OUD in the primary care setting should be supported and expected.

Darius A. Rastegar, MD

Reference: Sosnowski DW, Feder KA, Genberg BL, et al. Association of primary care engagement with initiation and continuation of medication treatment for opioid use disorder among persons with a history of injection drug use. Drug Alcohol Depend. 2024;262:111383.