Many Docs Still Don't Understand Opioid Dependence

Deborah Brauser

June 14, 2013

Misperceptions about opioid dependence, including how to screen for and treat the disorder, continue to persist for the public and for many clinicians, new research suggests.

An online survey of 1000 adults chosen at random plus 200 primary care physicians who were not addiction certified showed that almost half of the first group and a third of the latter said they believe that opioid dependence "is more of a psychological problem," such as a lifestyle choice, than a chronic physical illness.

In addition, 35% of the clinicians admitted that they do not know much about opioid dependence; 66% said they feel that a low level of education is a likely cause of the disorder; and 57% said that low income was a likely cause.

"Opioid dependence is an equal opportunity disease and affects 10% to 12% of the population," Mark L. Kraus, MD, assistant clinical professor of medicine at the Yale University School of Medicine in New Haven, Connecticut, and chief medical officer of Connecticut Counseling Centers, an addiction treatment program, told Medscape Medical News.

He added that "it was surprising" to see that so many members of the treatment community have contributed to perpetuating stigma for these individuals.

"Physicians feel that this is a disease. But they think it's more of a psychological one than a chronic brain disorder, as it's defined by the American Society of Addiction Medicine. It actually contributes neurophysical chemical changes to the brain."

Dr. Kraus served as an advisor and reviewer on the development of the survey but was not part of the actual process. Reckitt Benckiser Pharmaceuticals Inc, the manufacturer of the opioid treatment medication sublingual buprenorphine/naloxone (Suboxone Film), commissioned the survey.

"The information we've garnered from this survey will serve as a strong cornerstone for our future educational efforts among both the US public and doctors," said Richard Simkin, president of Reckitt Benckiser, in a release. The survey results were released by the company on June 11.

Shedding Light on Barriers

A total of 1000 Americans between the ages of 26 and 49 years filled out the online survey between January 2 and January 7, 2013, as did 200 non–Drug Addiction Treatment Act of 2000 (DATA 2000) certified primary care, family practice, and internal medicine physicians between March 13 and March 22, 2013.

Results showed that 12% of the adults reported personally struggling with opioid dependence, which the surveyors point out is more than those who struggle with diabetes (7%) or cancer (3%).

However, only 59% of the adults and 88% of the clinicians said that this type of addiction is a disease, and 80% of the clinicians said that the condition "represents a mental health problem."

The survey also found that 77% of the adult participants and 93% of the clinicians said that shame, embarrassment, or fear that others would find out are among the main reasons why those with the addiction might not seek treatment.

Although 71% of the adults and 85% of the clinicians said that many of these people think they can stop their addiction on their own, 83% and 92% agreed that a long-term combination of medication and behavioral changes is needed for successful treatment.

Interestingly, only 44% of all adults said that they were aware that prescription medication exists as a treatment option.

"The survey sheds light on barriers beyond the commonly perceived lack of patient recognition of the disease and motivation to seek treatment," said Simkin.

Stigma Persists

Other notable findings from the survey include the following:

  • 27% of the primary care physicians said they thought that any physician can prescribe medication to someone with opioid dependence;

  • 31% thought they did not need DATA 2000 certification to treat these patients; and

  • 7% said that they prefer to not treat these patients in any way.

The most commonly cited reasons for not wanting to treat patients with opioid dependence included that they are difficult to treat, that it would require too much paperwork or take up too much office staff time, and that clinicians did not want to be viewed as having an addiction practice.

"The stigma that unjustly exists towards those who suffer from opioid dependence could negatively impact or even prevent people from receiving the care they need," said Dr. Kraus in a release.

"There is a desperate need for doctors who are willing to treat opioid dependence as they would other chronic diseases."

He told Medscape Medical News that this includes realizing the need to do screenings and then to initiate a brief intervention, if needed, followed by a referral to a specialist.

"All Hands on Deck"

"If I have a cardiac patient and feel that I don't have enough understanding or that they need more help, then I'll refer them to a cardiologist. We already have that type of paradigm where the generalist will refer to a specialist," said Dr. Kraus.

"So we need to recognize that there are addiction specialists who could help with a patient and get a treatment plan together, and then turn them back to the practitioner. That fits the pattern for what we do every day in general medicine."

He noted that the Centers for Disease Control and Prevention announced in 2012 that opioid dependence is a public healthcare crisis, affecting 12 million people who are older than 12 years.

"So I think we need to get all hands on deck and increase the understanding of what this is all about," said Dr. Kraus.

"The press and those of us in the addiction community need to push and explain that this is an equal opportunity disease, there are medical-assisted treatments available, and those treatments plus behavioral therapies such as counseling can lead to a favorable outcome," he concluded.

Dr. Kraus reports having received unrestricted grants from and being a consultant and on the speakers' panel for Reckitt Benckiser Pharmaceuticals, as well as being a speaker for Forest Laboratories, Inc., and Pfizer Inc.