Primary Care Doctors See Addiction as Treatable Yet Refuse to Prescribe Medications—Ohio University Study Reveals Disconnect

Primary care physicians across Ohio hold surprisingly warm attitudes toward patients with opioid use disorder and consider addiction more treatable than Type 2 diabetes—yet the vast majority refuse to prescribe medications that could save lives. New research from Ohio University's Heritage College of Osteopathic Medicine has uncovered a troubling disconnect between medical knowledge and clinical practice that leaves rural communities struggling to access evidence-based addiction treatment.

Berkeley Franz, professor of community-based health at Ohio University, led a team investigating why medication-assisted treatment remains so difficult to access in regions hardest hit by the opioid epidemic. Southeast Ohio has been ground zero for overdose deaths over the past decade, but patients seeking buprenorphine—the gold-standard medication for opioid use disorder—often travel hours to specialty clinics or wait weeks for appointments while primary care offices a few blocks away decline to help.

"We're actually very lucky to have a medication that works really well for opioid use disorder," Franz told WOUB's Modern Science. "It prevents overdose deaths. It also prevents infectious disease transmission. But a lot of health care professionals are not willing to prescribe it."

The statistics are stark: only 8 percent of family medicine physicians licensed in Ohio have ever prescribed buprenorphine, despite federal regulations eliminating the special waiver requirement in 2023. Any DEA-licensed practitioner can now prescribe the medication, yet the overwhelming majority choose not to.

The Diabetes Comparison Experiment

Franz and her research team designed a study to understand whether stigma was driving the treatment gap. They presented primary care providers with two identical patient vignettes—one describing someone with opioid use disorder, the other with Type 2 diabetes. The patients were matched on all characteristics: demographics, medical history, insurance status, and willingness to engage with treatment. The only difference was the diagnosis.

Providers rated their willingness to treat each patient in primary care versus referring to a specialist, their attitudes toward the patient, and their beliefs about whether the disease was within the patient's control.

The results challenged conventional assumptions about addiction stigma. Primary care physicians actually expressed warmer attitudes toward patients with opioid use disorder than those with diabetes. They were less likely to blame patients for their addiction than for developing Type 2 diabetes, which they saw as more within individual control. And crucially, they viewed opioid use disorder as more treatable than diabetes.

"They thought Type 2 diabetes was actually more within the control of the patient, so they were more likely to blame the patient for their condition versus people with opioid use disorder," Franz explained. "They also thought opioid use disorder was more treatable, which is also very surprising. It goes against a lot of the ideas that we have about stigma towards addiction treatment."

Yet despite these positive attitudes and optimistic assessments of treatability, the same physicians overwhelmingly preferred to refer addiction patients to specialists rather than treat them in primary care—even though they routinely manage diabetes, hypertension, and other chronic conditions requiring ongoing medication.

The Implementation Breakdown

The contradiction reveals that stigma alone cannot explain the treatment gap. Something else is preventing primary care providers from translating their knowledge and attitudes into action.

"The providers saw opioid use disorder as treatable," Franz said. "Yet there's medication available to treat opioid use disorder, but very few primary care providers are prescribing it. They still preferred to send patients outside to refer them to a specialist of some sort. That's where the breakdown is happening."

Part of the problem is training. Medical schools provide minimal instruction on addiction medicine, and residency programs rarely include supervised experience prescribing buprenorphine. Physicians who have never initiated a patient on medication-assisted treatment understandably lack confidence, even if they theoretically understand the pharmacology.

"Some of it is a training problem," Franz noted. "Primary care providers get very little training on how to treat addiction. Some of it's a confidence problem. If you haven't done it before, you're not going to be very confident in doing it."

But the research also uncovered a deeper issue: many primary care providers simply do not view addiction treatment as belonging in their domain. Despite recognizing opioid use disorder as a treatable medical condition, they have internalized the idea that it requires specialty care—much like they might refer complex cardiology cases or rare neurological disorders to specialists.

The difference, of course, is that cardiology and neurology specialists are available in most communities. Addiction medicine specialists are not. In rural Ohio and similar regions across the country, the nearest addiction treatment provider may be an hour or more away. Transportation barriers, work schedules, childcare responsibilities, and the logistical demands of weekly appointments at distant clinics create nearly insurmountable obstacles for many patients.

The Rural Access Crisis

The consequences of primary care providers declining to treat addiction are particularly severe in rural areas. Southeast Ohio lacks the concentration of specialty services found in urban centers like Columbus or Cleveland. For residents struggling with opioid use disorder, being told their family doctor cannot help and they must travel to a distant clinic often means going untreated.

"Transportation is a very important barrier," Franz emphasized. "That's another reason not to send patients to multiple settings for treatment they could receive in the same location. That's going to really limit the ability of patients to either have to choose, do you want to get your flu shot and any other chronic disease addressed, or do you want to receive addiction treatment?"

The research team is now working to develop interventions that could normalize addiction treatment in primary care settings. Rather than focusing on changing attitudes—which the study found are already reasonably positive—they are targeting the confidence and competence gap through peer mentorship programs.

"We're actually pairing primary care providers in rural areas with other primary care providers who can provide mentorship on addiction training," Franz said. "Because what we do know from the science of this is that when you see somebody else doing this, you're actually more confident and have more positive attitudes towards doing it in primary care."

The mentorship model addresses both the technical aspects of prescribing buprenorphine—assessing withdrawal severity, determining appropriate dosing, managing side effects, coordinating with counseling services—and the psychological barrier of feeling unprepared to handle a complex medical condition. Seeing colleagues successfully integrate addiction treatment into routine primary care demonstrates that it is feasible and appropriate within their scope of practice.

The Evidence for Primary Care MAT

Buprenorphine is a partial opioid agonist that eliminates cravings and withdrawal symptoms while blocking the euphoric effects of other opioids. Patients maintained on buprenorphine experience dramatically reduced overdose risk—studies have shown mortality reductions of 50 percent or greater compared to no treatment.

The medication is remarkably safe. Unlike full opioid agonists such as heroin or fentanyl, buprenorphine does not cause dangerous respiratory depression at therapeutic doses. It can be prescribed and dispensed through regular pharmacies, unlike methadone which requires daily supervised dosing at specialized opioid treatment programs.

These characteristics make buprenorphine ideally suited for primary care. Patients can receive their prescription during the same visit where they get diabetes medication adjusted or blood pressure checked. They pick up their supply at the same pharmacy where they fill other prescriptions. They do not need to disclose their addiction treatment to employers or coordinate time off work for clinic visits.

Yet the infrastructure to support primary care buprenorphine prescribing remains underdeveloped. Many electronic health record systems lack templates for documenting addiction assessments. Insurance companies sometimes impose prior authorization requirements or fail to reimburse adequately for the time involved in addiction care. Office staff unfamiliar with buprenorphine may inadvertently create barriers through scheduling or patient interaction.

And perhaps most significantly, the medical culture has not yet fully embraced addiction treatment as core primary care. Physicians who enthusiastically manage the complexities of diabetes, heart disease, and psychiatric conditions balk at opioid use disorder—not because they view patients negatively or consider the condition hopeless, but because they do not see it as their role.

Normalizing Addiction as Healthcare

Franz argues that changing this perception is critical to expanding access in underserved regions. "We really need to normalize addiction treatment as just part of healthcare and not make it more difficult and put more barriers in place for people to receive evidence-based health care," she said.

The Ohio University research suggests progress is possible. Attitudes toward patients with addiction have improved significantly over the past decade. Primary care providers no longer view addiction as a moral failing or character weakness—they recognize it as a chronic medical condition influenced by genetics, neurobiology, trauma, and social circumstances.

What remains is translating that recognition into practice. If physicians can prescribe insulin for diabetes based on hemoglobin A1C levels and patient symptoms, they can prescribe buprenorphine for opioid dependence based on Clinical Opiate Withdrawal Scale scores and patient history. If they can counsel patients about dietary changes and exercise while managing metabolic disease, they can discuss recovery support and behavioral interventions while managing addiction.

The mentorship programs Franz and her colleagues are developing aim to demonstrate that integration. Early participants report that once they prescribe buprenorphine for their first few patients, the anxiety diminishes and the process becomes routine. They discover that addiction treatment does not require hours of appointment time or specialized training beyond what they already possess. Patients are grateful, outcomes are often excellent, and the work feels meaningful.

The Larger Treatment Desert

Ohio is not unique. Across rural America, primary care providers represent the only realistic pathway to medication-assisted treatment for most people with opioid use disorder. Specialty addiction medicine clinics are concentrated in urban areas. Residential treatment programs are expensive and require patients to leave their jobs and families for weeks. Telehealth has expanded access but still requires patients to find providers willing to prescribe.

The Substance Abuse and Mental Health Services Administration estimates that only about 20 percent of people with opioid use disorder receive any treatment in a given year. Of those who seek help, many encounter barriers—waitlists, insurance denials, geographic distance, lack of transportation, or simply providers who decline to accept them.

If even a modest fraction of the 92 percent of family medicine physicians in Ohio who have never prescribed buprenorphine began doing so, the impact would be transformative. Multiply that across the country and hundreds of thousands of additional patients could access evidence-based treatment through doctors they already know and trust.

The Ohio University research reveals that the barrier is not physician hostility or skepticism about treatment effectiveness. It is confidence, competence, and the cultural perception that addiction requires specialty care. All three can be addressed through training, mentorship, and institutional support.

For the patients waiting weeks for addiction treatment appointments while their family doctor manages their blood pressure, the distinction between willingness and ability offers little comfort. But for policymakers, healthcare systems, and medical educators, understanding that primary care providers already view addiction as treatable points toward achievable solutions.

The question is not whether primary care can treat opioid use disorder—the medications exist, the evidence is robust, and the regulatory barriers have been removed. The question is whether the healthcare system will invest in the training, infrastructure, and cultural shift necessary to make that treatment available where patients actually live.

Southeast Ohio has buried too many people who could have survived with medication-assisted treatment. Berkeley Franz and her colleagues are working to ensure that fewer families receive that terrible news because the local doctor felt unprepared to prescribe a medication that could have saved a life.

The research suggests that preparation is more achievable than anyone previously believed. What remains is the will to make it happen.