New study led by OHIO researcher reveals surprising attitudes among Ohio primary care providers toward diabetes vs. opioid use disorder treatment

A recent study published in JAMA Network Open, titled "Health Care Professional Willingness to Treat Opioid Use Disorder vs Type 2 Diabetes in Primary Care," reveals surprising insights into how primary care providers in Ohio perceive and treat opioid use disorder (OUD) differently from other chronic conditions, such as type 2 diabetes.

The study, led by Dr. Berkeley Franz of Ohio University, in collaboration with researchers from Rutgers University, The Ohio State University, and NYU, surveyed nearly 400 primary care professionals across Ohio, including physicians, nurse practitioners and physician associates, to assess their interest and willingness to treat opioid addiction in primary care settings. This focus is especially critical in underserved and rural areas where access to specialty addiction care is limited.

“We expected stigma to play a large role,” said Franz, professor of Community-based Health at the Ohio University Heritage College of Osteopathic Medicine and Osteopathic Heritage Foundation Ralph S. Licklider, D.O. Endowed Professor in Community and Behavioral Health. “But what we found was even more complicated, and in some ways, more promising.”

In the study, participants reviewed simulated clinical notes where fictitious patients presented with chief complaints. Each note was randomized to describe either a patient with type 2 diabetes or OUD, but was otherwise identical. Providers were then asked how they would respond to each case. The responses revealed stark differences in treatment approaches, despite many providers expressing more empathy toward patients with OUD.

According to Franz, providers generally saw OUD as less within the patient’s control than diabetes. Yet, despite this understanding, providers were still significantly less likely to offer treatment for OUD themselves. Instead, they opted to refer patients to specialists or abstinence-focused programs, even though effective, FDA-approved medications for OUD can be prescribed in the primary care setting.

"Diabetes was seen as harder to treat and more within the patient’s control,” Franz explained. “But despite recognizing that opioid use disorder is a chronic, relapsing brain disease and not just a behavior problem, providers were still reluctant to treat it themselves."

Dr. Lindsay Dhanani, co-investigator and associate professor at Rutgers University, who also led the experimental design and data analysis, emphasized the complexity of the stigma involved.

“There are stigmatizing beliefs for both opioid use disorder and type 2 diabetes, some of which are relatively similar in nature,” she said. “People may believe these conditions are solely due to personal choices or may view setbacks in recovery as a lack of willpower or other personal failing. Yet, they are both more complicated than that, and health care professionals play a key role in helping patients manage the disease.”

One of the study’s most surprising findings was that participants rated the likelihood of disease stabilization higher for patients with OUD than those with diabetes, yet were still less likely to treat them directly.

“This could suggest that health care providers don’t feel as confident working with this population, which is an important training gap that needs to be addressed, if true,” Dhanani said.

According to Dhanani, the team was interested in conducting this study because both Type 2 diabetes and OUD are difficult conditions to manage that require perhaps more than the average investment from health care professionals.

“We often hear that health care professionals are reluctant to treat opioid use because of these challenges. If that were the only barrier, we would then expect to find that health care professionals were similarly willing to treat patients with OUD and patients with Type 2 diabetes,” Dhanani explained. “However, what we found is that there were differences; participants were more willing to treat patients with Type 2 diabetes and were more likely to refer patients with OUD elsewhere.”

The reluctance, the researchers argue, isn’t just about stigma but also about perceived compatibility. Many providers view addiction treatment as something that doesn't "belong" in primary care.

“Addiction treatment is not being offered as widely as it should be in this critical practice setting,” Franz said. “Ohio, a state disproportionately affected by the opioid crisis, experiences high rates of opioid use and very few patients receive evidence-based care. This makes it especially important to study these issues in our state. The key question is how to encourage providers to offer addiction treatment at a scale that meets the needs of the population.”

Franz added that Ohio ranks 12th in the nation for overdose deaths and for a long time, it ranked second. Southern Ohio, in particular, sees overdose rates that are three times the national average. The state has also been called the epicenter of the prescription opioid epidemic, in part due to the historical presence of "pill mills."

Meanwhile, the health burden of diabetes is also significant. Around 13.2% of Ohioans have diabetes, a figure that is even higher in rural areas and Ohio currently ranks 39th for diabetes-related outcomes.

A 2023 JAMA study further underscores the urgency of expanding access noting that fewer than one in five patients who needed medication for OUD were able to access it within the last year.

In light of these disparities, Franz and her team are now working on implementation strategies to better support primary care providers. One approach involves a peer mentorship model, pairing experienced addiction treatment providers with those new to the field to offer guidance on prescribing medications for opioid use disorder.

“This is a really important setting, and more work is needed to help people understand the compatibility of addiction treatment within primary care,” Franz said. “We’ve been collaborating with primary care providers and other specialists who do this work, sharing successful examples to demonstrate its value. Having peer mentors and support systems in place can be very helpful for providers integrating addiction treatment into their practice.”

Franz also noted that there are also organizational factors that need to be addressed, such as preparing staff for the changes, determining how often patients should be seen and allowing flexibility for longer or more frequent visits, especially when prescribing medication.

The researchers also highlighted the growing push for integrated care, especially within rural and underserved communities. Primary care providers often serve as the first and sometimes only point of contact for many patients who may not seek or have access to specialty care.

“There is a growing push to offer integrated care within primary care settings, addressing multiple health needs in one place,” Franz explained. “This is especially important because many people never access specialty services due to barriers like transportation or stigma, particularly in rural areas where options are limited. Visiting a psychiatrist or opioid treatment center can carry stigma, especially in small towns where privacy is a concern.”

While family physicians are authorized to prescribe medications for OUD, only about 8% currently do so despite the urgent need.

“Diabetes care is equally important and common, but opioid addiction treatment is also vital for prevention and screening,” Franz said. “Primary care providers build long-term relationships with patients, understanding their history and providing comprehensive care across multiple chronic diseases, making them uniquely positioned to excel in managing both addiction and other health conditions.”

The researchers hope their findings will spark broader conversations about how to make primary care more inclusive of addiction treatment and ultimately more responsive to the needs of the communities it serves.

“Our ongoing efforts will focus on designing and testing interventions that may reduce stigma toward patients with opioid use disorder to ensure that they have access to the life-saving treatment they need,” Dhanani added.

“We don’t need to reinvent the wheel,” Franz said. “We just need to help providers see that treating addiction is part of what they’re already doing, caring for patients over the course of their lives.”