Induction of Medication for Opioid Use Disorder in Primary Care

Overdoses and deaths from synthetic opioids grew sharply in the past decade. Most people with opioid use disorder (OUD) do not receive recommended evidence-based treatment: nationally, 72% to 87% of people who need OUD treatment do not receive medication for opioid use disorder (MOUD). Little is known about practice teams' experiences with home, office, and telehealth induction for MOUD, particularly in primary care.

We conducted semistructured interviews with primary care clinicians and staff from February through September 2023 to understand experiences providing MOUD via home, office, and telehealth induction. Interviews were part of a PCORI-funded trial, Home versus Office versus telehealth for Medication Enhanced Recovery (HOMER). We used template and editing coding styles to categorize text according to deductive codes derived from research questions and inductive codes derived from multiple readings of transcripts. We used immersion-crystallization to iteratively review coded text and identify interview themes.

Thirty-eight clinicians and staff from 21 US primary care practices participated in interviews. Home induction is increasingly common and preferred by patients and practice teams, social determinants of health affect induction and maintenance in treatment, clinicians and staff use honest communication to build trusting relationships with patients, practices identified patients as MOUD candidates through word-of-mouth and referrals, and an evolving OUD landscape are causing practices to adapt their care.

Primary care practices are committed to offering MOUD. Findings offer insights about the challenges facing primary care practices in their efforts to deliver MOUD to address a rapidly evolving opioid epidemic.