Primary Care Patients With Opioid Use Disorder Symptoms: Initiation and Engagement in Treatment With Medicine

There is a critical need to treat opioid use disorder (OUD) in primary care. We describe the incidence of OUD medication treatment among primary care patients who reported opioid use and moderate or severe symptoms of substance use disorder (SUD), as defined by the Diagnostic and Statistical Manual of Mental Illnesses, Fifth Edition, Text Revision (DSM-5-TR), during routine care.

This retrospective cohort study used electronic health record and insurance claims data from 33 primary care clinics in Washington that routinely screen for substance use and ask patients who report daily cannabis use or any past-year drug use to complete a DSM-5-TR Substance Use Symptom Checklist (Checklist). The sample included 1,502 adult primary care patients (from March 1, 2015 to January 1, 2023) who completed a Checklist, reported past-year opioid use, and had no recent OUD treatment. Primary outcomes were OUD medication treatment within 14 days of completing the Checklist (ie, initiation), and in the following 34 days (ie, engagement).

Among 80 (5%) patients with moderate symptoms, 8 (10%) initiated and 6 (8%) remained engaged with medication treatment. These patients were significantly more likely to initiate (P < .001) and remain engaged (P = .003) compared with the 746 (50%) reporting no SUD symptoms. Among 542 (36%) patients with severe symptoms, 141 (26%) initiated and 108 (20%) engaged. These patients were also significantly more likely to initiate (P <.001) and remain engaged (P <.001) compared with those with no SUD symptoms (P = .003) or moderate SUD symptoms (P = .009).

Most primary care patients reporting opioid use and moderate or severe SUD symptoms did not initiate OUD treatment, but most who initiated remained engaged. Screening and assessment alone is insufficient to result in adequate OUD medication treatment.