Despite the growing need for substance use disorder (SUD) treatment, physicians remain reluctant to treat addiction.

That’s according to a new systematic review published in JAMA, which included a total of 283 articles. Researchers found that the most common reason doctors were reluctant to intervene in addiction was the institutional environment.

Authors of the study noted that an increase in focus from health care institutions could help remedy this barrier.

“Strategies to reduce physician reluctance related to institutional environment include greater commitment by health systems to make essential workflow and staffing changes, the breaking down of barriers between addiction services and both medical and mental health care, and commitment by insurers to provide reimbursement that covers the actual cost of providing addiction interventions,” authors of the study wrote.

More than 70% of articles reported that knowledge, lack of skill and knowledge were reasons for not intervening in addiction.

Researchers noted that many addiction interventions are not sufficiently adapted for a variety of practice settings. Additionally, there is often a lack of opportunities for doctors to observe and practice addiction interventions under supervision.

“Ongoing training is critical for physicians to acquire and apply advanced skills in the care of this patient population, but few opportunities exist to observe and be observed practicing new skills once required medical training is complete,” authors note.

SUD remains a critical issue in the U.S. In 2022, overdoses were involved in more than 107, 941, according to the study. 

Recently, there has been a push for primary care providers (PCPs) to increase their involvement in combating the opioid epidemic.

In 2023, the Drug Enforcement Agency eliminated the so-called X waiver, which required physicians, nurse practitioners and physician assistants to have special training before prescribing medication-assisted-treatment (MAT) for opioid use disorder (OUD). This opened up the door for PCPs and other clinicians to prescribe the medications.

Still, there is a big gap in public knowledge about who can prescribe MAT. A recent study funded by the National Institutes of Health (NIH) and published in JAMA Network Open found that the majority of the public do not know that primary care physicians can prescribe these medications or incorrectly believe physicians outside of psychiatry cannot.