The overdose epidemic in the United States continues to escalate, with 107,941 overdose deaths recorded in 2022. Despite ongoing efforts to train and support physicians in implementing medications and other evidence-based substance use disorder interventions, the adoption of these practices remains remarkably low. A recent systematic review aims to describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices.

Study Design and Data Sources

This systematic review included a literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network, covering articles published from January 1, 1960, through October 5, 2021. The study selected publications that involved physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction care.

Data Extraction and Analysis

Two reviewers independently reviewed each publication, with a third reviewer resolving any discordant votes. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and used the theoretical domains framework to systematically extract reasons for reluctance.

Main Findings

Prevalence of Reluctance Reasons

A total of 183 out of 9,308 returned studies were included, reporting data collected from 66,732 physicians. Most studies utilised survey data. The substances most often studied were alcohol, nicotine, and opioids, while the interventions most frequently examined were screening and treatment.

The most common reasons for physician reluctance to address substance use disorder were:

• Lack of Institutional Support: Reported in 81.2% (173 of 213 articles)
• Lack of Knowledge: Reported in 71.9% (174 of 242 articles)
• Lack of Skill: Reported in 73.9% (170 of 230 articles)
• Cognitive Capacity Issues: Reported in 73.5% (136 of 185 articles)
• Reimbursement Concerns

Associations with Practice Setting and Drug Type

Bivariate analysis revealed associations between these reasons and various factors such as physician specialty, intervention type, and the specific drug involved. These associations suggest that targeted strategies may be necessary to address the unique barriers faced by different physician groups and practice settings.

Implications for Practice

The findings underscore the need for targeted interventions to address the barriers identified by physicians. Education and training, policy development, and program implementation can help improve the adoption of evidence-based practices (EBPs) for substance use and addiction care. Future research should aim to use a theoretical framework and adhere to best practices for survey development to enhance the reliability and validity of the findings.

Source: JAMA Network