Health Care Professional Willingness to Treat Opioid Use Disorder vs Type 2 Diabetes in Primary Care

A substantial implementation gap remains for medications for opioid use disorder (MOUDs), which prevent overdose and associated morbidities. Primary care is an important setting for expanding access opioid use disorder (OUD) treatment.

To compare primary care professional (PCP) willingness to treat OUD vs type 2 diabetes in primary care and to assess whether patient race is associated with shaping decisions to treat either condition.

This cross-sectional study used a 2 (chief concern of OUD compared with type 2 diabetes) × 2 (Black compared with White race) experimental design. Physicians, nurse practitioners, and physician assistants practicing in primary care or a related discipline in Ohio were randomly assigned to each condition and completed assessments between March 1 and June 6, 2024.

Participants received fictitious patient profiles that were identical except that they either described the chief concern as OUD or type 2 diabetes and specified the patient's race as Black or White.

Clinical and attitudinal outcomes, including willingness to treat the patient in primary care, the amount of time the participant would spend with the patient, and perceptions of the likelihood of disease stabilization, were assessed using 5-point Likert scales (1 = extremely unlikely or strongly disagree, 5 = extremely unlikely or strongly agree). For OUD only, willingness to provide MOUD treatment and harm reduction were assessed.

A total of 375 participants provided complete data (mean [SD] age, 46.8 [13.6] years; 235 female [62.7%]), of whom 191 (50.9%) were physicians (MD or DO), 104 (27.7%) were nurse practitioners, and 80 (21.3%) were physician assistants. Participants viewed type 2 diabetes as more complicated to treat, viewed patients with type 2 diabetes as more responsible for their diagnosis, and had more empathy toward patients with OUD. Participants were significantly more willing to treat type 2 diabetes in primary care (mean [SD], 4.4 [0.1] vs 3.6 [0.1] in the OUD condition) and more likely to refer patients with OUD to a specialist (mean [SD], 4.4 [0.1] vs 3.3 [0.1] in the type 2 diabetes condition). No significant treatment differences were found by patient race. Participants were moderately likely to prescribe an MOUD to the hypothetical patient, with slightly higher willingness to prescribe naltrexone (mean [SD], 3.7 [1.2]) than buprenorphine (mean [SD], 3.4 [1.3]). The most strongly endorsed treatment was referral to an abstinence-based residential treatment organization (mean [SD], 3.9 [1.2]).

These findings suggest that PCPs have positive attitudes toward treating OUD yet more willingness to treat type 2 diabetes in primary care. Future implementation studies are needed to support MOUD prescribing in primary care.