One resolution at this year’s meeting of the American Association of Family Physicians (AAFP) with family physicians’ inability to prescribe methadone in the primary care setting for treatment of opioid use disorder. Resolution co-author Taylor Boland, M.D., of the University of Wisconsin Department of Family and Community Health’s Madison Family Medicine Residency Program, told a reference committee that physicians need more options for battling OUD. “As we all know, [buprenorphine] is a recent option for OUD, and that can be prescribed in the primary care setting with an eight-hour training session. And even though we’re able to prescribe methadone for our primary care patients for chronic pain and pain conditions, we can’t prescribe it for OUD,” said Boland. The resolution noted that the Narcotic Addiction Treatment Act of 1974 allows for treatment of OUD with methadone only by federally licensed narcotic treatment programs.
Unfortunately, some patients can’t tolerate [buprenorphine], said Boland. “Methadone is another option for them, but I can’t prescribe it in my primary care clinic, so I have to send them to a methadone clinic. I work in a rural area. Patients aren’t going to travel 30, 40, 55 minutes into town every day to get methadone,” she said. “These patients are at extreme risk of relapse if we’re stumbling to find an option for treatment.”
Erika Rothgeb, M.D., of the Clarkson Family Medicine Residency Program in Omaha, Neb., also co-authored the resolution. “We are very passionate about addiction medicine, and working on the opioid crisis is at the forefront of medicine. You can’t go a day without hearing about the opioid crisis and the new legislation that’s been enacted to address it,” said Rothgeb.
“I come from a largely rural state, and more than half our population lives in rural areas,” she added. However, “92% of methadone clinics are in urban areas, and so this is also about promoting rural care,” she added.
Residents adopted the resolution, which asked that the AAFP advocate for methadone maintenance treatment within primary care clinics without a separate federal license.