Brown School

Do business concerns keep doctors from treating opioid addiction?

One morning last week as I arrived at our new addiction treatment center, the CAPA Clinic in St. Louis, one of the social work student interns I supervise couldn’t wait to tell me about the “excitement” they’d experienced in the few hours the clinic had been open for the day: a patient had been stabbed, another was screaming in the waiting room and had to be removed by the police, and detectives arrived to arrest one of the clinic’s clients.

That got me thinking about my participation in a national panel of addiction experts whose work formed the basis for “Medications for Opioid Use Disorder Save Lives,” a new report from the National Academies of Science, Engineering, and Medicine. In it we noted that, despite the huge need for U.S. physicians to provide medication-assisted therapy for opioid use disorder, only a small number of them have signed up to do it. The panel recommended that more join in.

More than 2 million people in the United States have an opioid use disorder, which is caused by prolonged use of prescription opioids or illicit ones such as heroin and fentanyl. Opioid use disorder is a serious chronic illness — individuals who suffer from it have a twentyfold greater risk of early death due to overdose, infectious disease, trauma, and suicide.

According to the National Academies report, the current Food and Drug Administration-approved medications for opioid use disorder — methadone, buprenorphine, and extended-release naltrexone — are safe and highly effective medications for its treatment. These medications can ease or banish withdrawal symptoms and reduce cravings for opioids, which helps people lower their rates of relapse and avoid fatal overdoses.

The hubbub in our St. Louis clinic, a partnership between Washington University in St. Louis and Preferred Family Healthcare, brought home to me why some primary care physicians might be reluctant to take on the responsibility of providing medication-assisted therapy to their patients with opioid use disorder…

…With primary care’s business model relying on patient satisfaction, a small issue like patients getting upset and protesting which TV channel is playing in the waiting room could significantly affect a physician’s bottom line.

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