Substance Use Disorder (SUD) remains one of the most significant public health crises in the United States. With over 107,000 overdose deaths in 2022 alone, the urgency for effective treatment has never been greater. However, barriers to substance use disorder treatment persist, as many physicians remain reluctant to intervene in addiction care. This reluctance stems not from a lack of concern but from a complex set of systemic, institutional, and personal challenges that hinder physicians from addressing addiction in their practices. A recent systematic review published in JAMA highlights these critical barriers, offering a roadmap for improving addiction care in the U.S.
Institutional Environment as a Key Barrier to Addiction Care
The findings from the JAMA study make it clear that one of the most significant reasons for physicians’ reluctance to treat addiction is the institutional environment in which they practice. The healthcare system, as it currently stands, is often ill-equipped to support addiction care. Many healthcare settings do not integrate substance use treatment into their general care offerings, and those that do often lack the necessary resources, infrastructure, and support to make addiction treatment a priority.
According to the study, institutional barriers such as inadequate workflows, insufficient staffing, and a lack of coordination between addiction services and other medical and mental health care are some of the key reasons physicians shy away from treating addiction. The study’s authors argue that the healthcare system must undergo systemic changes to help doctors feel more equipped and supported in treating addiction.
“Strategies to reduce physician reluctance related to institutional environment include greater commitment by health systems to make essential workflow and staffing changes, the breaking down of barriers to substance use disorder treatment between addiction services and both medical and mental health care, and commitment by insurers to provide reimbursement that covers the actual cost of providing addiction interventions,” the study authors noted.
This call to action underscores the need for healthcare institutions to invest in not just addiction treatment but also the seamless integration of these services into existing systems of care. By doing so, physicians will have the resources and support they need to intervene more effectively in addiction cases.
Knowledge Gaps and Lack of Training: A Lack of Confidence in Addiction Care
Another major factor contributing to physicians’ reluctance to treat addiction is a lack of knowledge and training in addiction medicine. According to the JAMA study, more than 70% of the articles reviewed cited a lack of knowledge and skills as primary reasons for physicians not intervening in addiction cases. Physicians often do not feel confident in their ability to diagnose or treat substance use disorders, especially when it comes to managing complex cases or providing long-term care.
The review also revealed that addiction interventions are often not sufficiently adapted for various practice settings, which makes it difficult for physicians to apply evidence-based treatment protocols in their daily practice. Many addiction treatment techniques require specialized training that many physicians do not receive during their medical education. Additionally, there is often a lack of opportunities for doctors to practice addiction interventions under supervision, preventing them from developing the practical skills needed to treat this patient population effectively.
“Ongoing training is critical for physicians to acquire and apply advanced skills in the care of this patient population, but few opportunities exist to observe and be observed practicing new skills once required medical training is complete,” the authors emphasized.
Without sufficient training, physicians may feel overwhelmed by addiction cases or fear making errors in their treatment approach. The lack of hands-on learning opportunities further exacerbates these feelings of inadequacy, contributing to their reluctance to treat addiction at all.
The Call for Primary Care Providers (PCPs) to Become More Involved
In response to the opioid crisis and the broader substance use epidemic, there has been an increasing push for primary care providers (PCPs) to become more actively involved in addiction treatment. Many experts believe that involving PCPs more directly in the treatment of addiction could help address the shortage of addiction specialists and broaden access to care for those suffering from substance use disorders.
A pivotal change occurred in 2023 when the Drug Enforcement Administration (DEA) eliminated the so-called X waiver. This waiver previously required physicians, nurse practitioners, and physician assistants to undergo specialized training before they could prescribe medication-assisted treatment (MAT) for opioid use disorder (OUD). With the removal of this requirement, more clinicians, including PCPs, are now able to prescribe MAT medications, such as buprenorphine and methadone, which are critical for helping patients manage their opioid use disorder and reduce the risk of overdose.
While this policy change has opened up new avenues for addiction care, there remains a significant knowledge gap among both the public and healthcare professionals regarding who is eligible to prescribe MAT. A recent study funded by the National Institutes of Health (NIH) and published in JAMA Network Open found that the majority of the public is unaware that PCPs can prescribe MAT medications, with many mistakenly believing that only psychiatrists or addiction specialists are authorized to do so. This lack of public awareness could contribute to delays in patients seeking treatment or prevent them from accessing the care they need.
The Need for Public Education and Awareness
One of the overlooked aspects of addressing the addiction crisis is improving public knowledge about addiction treatment. Despite advances in policy, many patients remain unaware that they can seek help from a wider range of healthcare providers, including their primary care physician. The misconception that only addiction specialists can prescribe MAT creates a barrier to care, preventing individuals from receiving timely and appropriate treatment.
Educational campaigns aimed at both the public and healthcare providers could help bridge this knowledge gap. By increasing awareness about who can prescribe MAT and the different treatment options available, these campaigns could encourage more people to seek help for their addiction. Furthermore, educating the public about the effectiveness of MAT in treating opioid use disorder and other substance use issues could reduce stigma and promote a more supportive environment for people in recovery.
Ongoing Training and Continuing Education for Physicians
To combat the reluctance of physicians to treat addiction, ongoing training and continuing education are essential. Medical schools often fail to adequately teach addiction medicine, leaving many physicians without the knowledge or skills to manage addiction cases. Continuing education programs, workshops, and supervised practice opportunities could help doctors develop the expertise needed to treat addiction with confidence.
Moreover, addiction care should be incorporated into the general curriculum for physicians, so they are better prepared to identify and treat SUDs from the outset of their careers. Training should focus not only on the pharmacological aspects of addiction treatment but also on the psychosocial and behavioral elements that are integral to a comprehensive approach to recovery.
Systemic Change and Improved Reimbursement for Addiction Care
Finally, addressing the reluctance of physicians to treat addiction requires systemic change in how addiction care is reimbursed and valued. Barriers to substance use disorder treatment, such as inadequate reimbursement rates, must be addressed. Insurers need to commit to providing rates that reflect the actual costs of addiction interventions. Current models often fail to cover the time, resources, and expertise required for high-quality care. As a result, many physicians may be discouraged from treating addiction due to financial concerns or insufficient support from insurance providers.
Health systems must also ensure that addiction services are fully integrated into primary care settings, providing physicians with the support they need to offer comprehensive care. This integration could include offering behavioral health services within primary care clinics and ensuring that physicians have access to addiction specialists for consultation when needed.
Conclusion: Moving Forward with Addiction Care
As the opioid crisis and other substance use disorders continue to devastate communities across the U.S., it is essential that healthcare systems take more proactive steps to address addiction in medical settings. Physicians’ reluctance to treat addiction is a multifaceted issue that requires systemic change, enhanced training, and greater public awareness. By improving healthcare infrastructure, providing ongoing education for physicians, and ensuring better access to medication-assisted treatments, we can reduce the barriers to substance use disorder treatment and help physicians offer more effective care. In doing so, we can broaden access to care, save lives, and help those struggling with substance use disorders find a path to recovery.
