350 American Family Physician www.aafp.org/afp Volume 94, Number 5 ◆ September 1, 2016
Family Medicine: An Underutilized Resource
in Addressing the Opioid Epidemic?
JACOB CROTHERS, MD; STEPHEN PETTERSON, PhD; ANDREW BAZEMORE, MD, MPH; and PETER WINGROVE, BS
Opioid overdose rates have tripled since 2000, and
although overprescribing of opioids by physicians is
widely accepted as a causal factor, the physician’s role in
providing medication-assisted treatment for opioid use
disorder is less appreciated. Despite a clear willingness
to prescribe opioids, few family physicians (FPs) have the
necessary certification to treat opioid use disorder with
buprenorphine, an effective, evidence-based treatment.
Opioid use disorder is a growing public health concern,
with the rate of opioid overdose deaths tripling since 2000
and 28,647 overdose deaths in 2014 alone.1 As a specialty
group, FPs prescribe more opioids (by total volume) than
any other individual medical specialty.2 Since 2000, FPs
have also been able to prescribe buprenorphine, an effective3 and U.S. Food and Drug Administration–approved
treatment for opioid use disorder. To provide this treatment, FPs must complete eight hours of training to obtain
a Drug Abuse Treatment Act (DATA) waiver, which allows
for treatment of up to 275 patients (30 in the first year).
We analyzed recently released 2013 Medicare Part D
data and the U.S. Drug Enforcement Administration’s
DATA waiver roster, and found that 77,278 FPs prescribed
opioids to Medicare patients in 2013. Among these,
34,671 (44.9%) prescribed 10 or more patient-years of
opioids (enough opioids to supply more than 10 patients
for the entire year), and 4,530 (5.9%) were licensed to
prescribe buprenorphine to treat opioid use disorder
(Figure 1). Therefore, although many FPs prescribe opioids, and a large number prescribe a significant amount,
a much smaller number are certified to prescribe a critical treatment for the growing opioid epidemic.
Efforts to improve the appropriateness of opioid prescribing by all physicians are already underway and have
received significant attention at the policy level.4 These
efforts are a positive step toward improving the primary
prevention of opioid use disorder. However, there has
not been a similar policy focus on the potential for FPs
to provide treatment for the epidemic with buprenorphine. Given the comparability of opioid use disorder to
other chronic diseases5 treated by FPs, this represents a
missed opportunity. Family medicine leaders and policy
makers should consider educational, maintenance of
certification, and policy interventions to increase FP
engagement in opioid use disorder treatment, and they
should adopt policies to encourage interest in treatment
within the family medicine community.
The information and opinions contained in research from the Graham
Center do not necessarily reflect the views or the policy of the AAFP.
This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.
A collection of Graham Center Policy One-Pagers published in AFP is
available at http://www.aafp.org/afp/graham. Policy One-Pagers are
available from the Graham Center at http://www.graham-center.org.
Author disclosure: No relevant financial affiliations.
1. Rudd RA, et al. Increases in drug and opioid overdose deaths. MMWR
Morb Mortal Wkly Rep. 2016;64(50-51):1378-1382.
2. Chen JH, et al. Distribution of opioids by different types of Medicare
prescribers. JAMA Intern Med. 2016;176(2):259-261.
3. Mattick RP, et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst
Rev. 2014;(2): CD002207.
4. AAFP. Pain management and opioid abuse. http://www.aafp.org/
patient-care/public-health/ pain-opioids.html. Accessed June 13, 2016.
5. McLellan AT, et al. Drug dependence, a chronic medical illness. JAMA.
Figure 1. Number of family physicians prescribing opioid
analgesics vs. those certified to prescribe buprenorphine
to treat opioid use disorder in 2013. (DATA = Drug Abuse
Information from 2013 Medicare Part D data and the U.S. Drug Enforcement Administration’s DATA waiver roster.
Physicians who prescribed any opioid analgesic (77,278)
Physicians who prescribed 10 or more patient-years
of opioids (34,671)
Physicians with a DATA waiver to prescribe buprenorphine
for opioid use disorder (4,530)
0 15,000 30,000 45,000 60,000 75,000 90,000
Graham Center Policy One-Pager