What is success in treatment for opioid use disorder? Perspectives of physicians and patients in primary care settings

Introduction

Clinicians and researchers have traditionally relied on treatment retention and opioid abstinence as the primary measures of treatment success for people with opioid use disorder (OUD). However, these measures may not capture the range of clinically important treatment outcomes. The study sought to identify indicators of success in primary care–based medication for OUD (MOUD) treatment from the perspectives of patients with OUD and the physicians who treat them.

Methods

The study recruited patients (N = 18; M age = 38.1 years, SD = 11.5; 44% female) and physicians (N = 14; M age = 34.6, SD = 6.8 years; 57% female) from two academic family medicine residency clinics in the upper Midwest to participate in semi-structured qualitative interviews. Participants reflected on signs of progress and success in primary care MOUD treatment. Interviews were recorded, transcribed, and analyzed using an inductive thematic analysis approach.

Results

Seven themes of success emerged: (1) staying sober; (2) tapering off buprenorphine; (3) taking steps to improve physical and mental health; (4) improved psychological well-being; (5) improved relationships; (6) improved role functioning; and (7) decreased stigma and shame. Interviews with both patients and physicians supported five of the seven themes, with patients also describing themes of tapering off buprenorphine and reduced stigma and shame.

Conclusions

Themes suggest that a wider view of success, in addition to maintaining sobriety, is needed when considering outcomes for MOUD programs delivered in primary care settings. Future work should identify appropriate outcome measures and potential adjunctive treatments.