Lawmakers are on a quest to break down barriers that keep most people with substance use disorders from getting the treatment they need. But lifting regulatory restrictions, as Congress did in late 2022 when it removed a training requirement for doctors to prescribe buprenorphine, which helps people who use fentanyl resist taking it, isn’t enough to increase access to treatment. A review of nearly 300 studies from the past 60 years, led by researchers from the National Institute on Drug Abuse and published Wednesday in JAMA Network Open, explored the reasons behind the reluctance of some physicians to treat addiction. The analysis found that most doctors say they lack: — Support from their employers, resulting in insufficient staff or training and challenges related to organizational culture and competing demands. This reason appeared in 81 percent of the reviewed studies. — Know-how, which came in second, appearing in about 74 percent of the studies. “Physicians reported lacking skills to conduct interventions effective enough to produce behavior change, including counseling and brief intervention,” the study reported. That also extended to lacking skills to initiate or manage treatment, particularly for substances other than alcohol and tobacco. — Cognitive capacity, which was generally characterized as doctors feeling too busy. In some cases, the physicians thought that treating addiction would be too time-consuming or were concerned that the demand for treatment would be too large for them to handle, the study found. — Certainty about how much they’d get paid for their work. Why it matters: With fatal drug overdoses still near record highs, health officials are eager to understand how to improve and expand access to treatment. Increasing the number of doctors and facilities providing addiction treatment is part of the effort, and understanding why providers are hesitant to do so is an important step in coming up with solutions. Dr. Nora Volkow, the National Institute on Drug Abuse director, said in a statement that “clinicians across all medical disciplines need greater training, resources, and support in caring for people with addiction, so that they feel prepared to proactively offer prevention, screening, treatment, harm reduction, and other tools that can help save lives.”
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