Evaluating the Impact of Multidisciplinary Care on Opioid Use Disorder: A Retrospective Study of Buprenorphine/Naloxone-Assisted Treatment in a Family Medicine Residency

Sally Mukatash Pauls^1*, Aubrey Baccari², Brian Henriksen²

¹Department of Pharmacy, Lutheran Hospital of Indiana, Fort Wayne, Indiana, USA

²Fort Wayne Medical Education Program, Fort Wayne, Indiana, USA

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Abstract

Background: Medications for Opioid Use Disorder (MOUD) with buprenorphine/naloxone improves opioid-use-disorder (OUD) outcomes, yet sustaining engagement is challenging. Pharmacist integration within MOUD teams enhances safety and adherence. We evaluated a pharmacist-augmented MOUD model embedded in a family-medicine residency clinic.

Methods: Adults with OUD treated between October 2020 and July 2024 formed a retrospective cohort. Eligibility required ≥ 1 clinic visit; polysubstance use excluded. Descriptive statistics summarized cohort characteristics; single-sample t-tests compared local outcomes with a published physician–pharmacist trial (Wu et al.). Variables included demographics, psychiatric comorbidities, induction site, Clinical Opiate Withdrawal Scale scores, urine drug screens (UDS), visit cadence, and retention rate.

Results: Fourteen of 30 screened patients met criteria (50% male; mean age 43 y). A clinical pharmacist participated in all MOUD visits. Induction was on-site for 78.6%, and 85.7% had ≥ 1 psychiatric comorbidity. Negative-UDS consistency was 85.7% versus 95.1% in Wu et al. (p = 0.21). The retention rate was 35.7% versus 88.7% in Wu et al. (p < 0.0001) but lay within the wider U.S. range of 19–64%. Two patients (14.3%) achieved remission after a median of six visits; three (21.4%) remained engaged ≥ 3 months.

Conclusions: Embedding pharmacists in a residency-based MOUD program yielded high medication adherence and UDS consistency comparable to collaborative-care trials, but retention lagged. Enhanced behavioral-health integration and provider continuity may bolster long-term engagement while preserving pharmacist-driven safety benefits.

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Background

Opioid use disorder (OUD) is a significant public health crisis in the United States, with over 81,083 opioid-related overdose deaths reported in 2023 alone, underscoring the urgent need for effective treatment strategies.¹ Medications for Opioid Use Disorder (MOUD; previously termed Medication-Assisted Treatment, MAT), particularly with buprenorphine/naloxone, has been instrumental in reducing overdose risks and improving long-term recovery outcomes for individuals with OUD.² Numerous studies confirm that MOUD not only decreases fatal overdose rates but also enhances treatment retention and overall quality of life.³

Family medicine residency clinics are uniquely positioned to deliver MOUD, especially in medically underserved areas, due to their accessibility and ability to provide continuous, comprehensive care.⁴ The recent removal of the DEA-X waiver requirement has further empowered family medicine physicians to prescribe buprenorphine/naloxone, broadening access to this crucial treatment.⁵ This regulatory change is pivotal in the fight against the opioid crisis, as it removes barriers that previously limited MOUD provision, thereby increasing the likelihood of reaching more individuals in need. These clinics are particularly effective in managing OUD patients in areas with limited access to psychiatric specialists, ensuring that necessary care is available close to home.

Buprenorphine, unlike methadone—which requires administration in certified opioid treatment programs (OTPs)—can be prescribed in primary care settings.⁴ This flexibility is critical for reducing opioid-related mortality, as it allows for earlier intervention and ongoing support, both of which are essential for long-term recovery.³^,⁴ Primary care settings also provide a broader reach, including to patients who might avoid specialized addiction centers due to stigma or logistical challenges.

Patients with OUD often face significant health impacts, including the loss of relationships and challenges in meeting work and family obligations.⁶ The American Academy of Family Physicians (AAFP) highlights that primary care providers are well-equipped to address these needs through patient-centered, continuous, coordinated, and comprehensive care.⁷ As the first point of contact for many individuals with OUD, particularly in rural and underserved areas, primary care providers play a crucial role in integrating Moud into routine care. This integration not only expands access to treatment but also helps to reduce the stigma associated with addiction, encouraging more individuals to seek help.⁸^,⁹

Supporting evidence for MOUD in primary care includes studies demonstrating high retention rates and sustained recovery. For example, a study by Deyo-Svendsen et al. found that 16 out of 20 patients in a rural family medicine practice maintained opioid abstinence after two years of treatment, with no patients lost to follow-up.¹⁰ Similarly, Mirer et al. reported significantly higher retention rates for patients receiving integrated MOUD in primary care compared to those treated separately, with 60% of integrated patients remaining in treatment after one year compared to 43% of those treated elsewhere.¹¹

Clinical pharmacists are integral to MOUD programs, as they optimize medication regimens, monitor drug interactions, and provide patient education, leading to reduced relapse rates and improved outcomes.¹² Wu et al. demonstrated the effectiveness of a collaborative care model involving buprenorphine-waivered physicians and pharmacists. This non-randomized, single arm, multisite, open-label trial included 71 patients, 6 physicians, and 6 pharmacists where patient care was transferred to pharmacists for 6 months. This study resulted in high treatment retention (88.7%) and low opioid-positive urine tests (4.9%) at 6 months alongside high patient satisfaction and no opioid-related safety events.¹³

Given the ongoing opioid crisis and the need for accessible treatment options, this quality improvement project aims to evaluate whether the collaboration between family medicine physicians and clinical pharmacists can enhance patient adherence and retention in MOUD programs at the Fort Wayne Medical Education Program (FWMEP). The project will assess retention rates, Clinical Opiate Withdrawal Scale (COWS) scores, pain scores, attempts to wean off buprenorphine/naloxone, and appointment progression. The goal is to determine whether this multidisciplinary approach can improve patient outcomes and more effectively address the opioid crisis. This study also seeks to advocate for broader implementation of MOUD within family medicine settings, leveraging recent regulatory changes to expand access to life-saving treatments.

Methods

Research Question(s)

• Population (P): Patients diagnosed with opioid use disorder (OUD) receiving Medications for Opioid Use Disorder (MOUD) in a family medicine residency clinic.
• Intervention (I): Management of MOUD by family medicine physicians with the support of a clinical pharmacist.
• Comparison (C): Not applicable (No comparison to psychiatric specialists).
• Outcome (O): Patient adherence to treatment and retention in the MOUD program.
• Research Question: In patients with opioid use disorder receiving medication-assisted treatment in a family medicine residency clinic, how does the involvement of family medicine physicians, supported by clinical pharmacists, impact patient adherence, health outcomes, and retention in the program?

Design: Retrospective chart review

Methods and Instruments

This study is a retrospective cohort study of all patients who received Medications for Opioid Use Disorder (MOUD) in residency clinic from October 2020 to July 2024. Patients were included if they met DSM-5 criteria for opioid use disorder and buprenorphine-naloxone was prescribed by a physician at the family medicine residency clinic. Excluded patients include those who refused MOUD services or presented with polysubstance use as these patients had a higher medical acuity and were referred out to addiction or psychiatric specialists. Polysubstance use was defined as the use of substances from more than one drug class (e.g., opioids plus psychostimulants, benzodiazepines, or cocaine). Patients who reported multiple opioids (e.g., oxycodone, hydrocodone, fentanyl, heroin, or morphine) were not considered polysubstance users, as these substances belong to the same drug class. Patients with confirmed methamphetamine or other stimulant use on UDS were excluded, while patients with a remote self-reported history of methamphetamine use but a negative UDS were included. Data points extracted from the electronic medical record include primary care physician, clinical pharmacist utilization, site of buprenorphine/naloxone induction, age, sex, ethnicity, psychiatric comorbidities, opioid use at time of induction, COWS assessment score, pain score if applicable, buprenorphine maintenance dose, wean attempts, total number of MOUD visits, appointment progression, total number of urine drug screens, retention in treatment and resources utilized. This quality improvement study aims to review all patients enrolled in a residency based MOUD program to determine if there are any trends.

Intervention Type: (no intervention)

Measures

1. Primary Care Physician
   1. MD
   2. DO
2. Clinical Pharmacist utilization
   1. Yes
   2. No
3. Where was the induction conducted?
   1. Internal- Family Medicine Residency clinic
   2. External – patient transferred care to residency clinic
      1. Clean Slate
      2. Psychiatry
      3. Outside family medicine provider
4. Age
5. Sex
6. Ethinicity
7. Psychiatric Comorbidities
   1. Depression
   2. Anxiety
   3. ADHD
   4. Schizophrenia
8. Prior use of opioid type
   1. Prescription opioid
   2. Heroin
   3. illicit fentanyl
   4. polysubstance – meth, cocaine, benzo ** excluded
9. General well-being of the patient (if documented)
   1. Observational statements
   2. Physical exam
   3. ROS
   4. PHQ-9 score
   5. GAD-7
   6. Insomnia Severity Index
10. vital signs (at initiation, 48-72 hours- if seen in office, 1 week post induction, at maintenance appointments)
    1. HR
    2. BP
    3. RR
11. Clinical Opiate Withdrawal Scale
    1. At initiation
    2. 48-72 hours post induction
    3. At 1-week post-induction
12. Pain score/assessment
    1. At initiation
    2. 48-72 hours post induction
    3. At 1-week post-induction
13. Buprenorphine maintenance dose
14. Has patient attempted to wean off
    1. Yes
       1. If yes, what was the approach to the wean?
    2. No
15. Total number of visits for MOUD
16. Appointment Progression?
    1. Progressed from weekly to monthly appointments
    2. Progressed from weekly to biweekly appointments
    3. Progressed from biweekly appointments to monthly appointments
    4. Progressed from monthly appointments to 60 day appointments
    5. Progressed from 60 day appointments to 90
17. Total number of urine drug screens
    1. Consistent
    2. Inconsistent
       1. Alcohol
       2. Benzo
       3. Other opioids
       4. Buprenorphine not present
18. Retention in treatment for patients receiving MOUD
    1. Patients still enrolled in our program
    2. Patients referred out
    3. Patients lost to follow up
    4. Patient relapsed
    5. Patient in remission
19. Resources Utilized
    1. Behavioral Health Services
    2. Narcotics Anonymous

Target number of participants/patients: 30

Inclusion Criteria

• Previous appointment at clinic within 3 years of chart review
• Opioid Use Disorder diagnosis
• Prescription for buprenorphine/naloxone

Exclusion Criteria

• <18 years old
• Polysubstance use
• Pain management only indication (no OUD)

How will the data be analyzed and represented (Statistical Tests)

Descriptive statistics will be applied where applicable and only where six or more patients have descriptive data available. All other data points will be assessed with single sample t-test methodologies with national numbers published in federal sites (i.e. CDC, AHRQ, Bureau of Labor and Statistics etc.) An alpha of 0.05 will be used for this study.

Study Timeline

• IRB submitted for September 6, 2024. This retrospective study was approved by the FWMEP IRB (Protocol # 58, 26 Sep 2024). Informed-consent requirement was waived.
• Pharmacy Resident started data collection during a rotation at FWMEP 9/23/24 – 10/18/2024
• Initial results presented at ASHP midyear (December 2024)
• Final Results presented at Great Lakes Regional Conference (April 2025)
• Manuscript finalized and submitted for publication (June 2025)

Study Site(s)

Fort Wayne Medical Education Program Clinic

Resources Needed

• Access to Athena
• Access to eCW

Impact on Family Medicine

The findings of this project could have implications for how MOUD programs are structured, particularly in primary care settings. If family medicine physicians, supported by clinical pharmacists, are shown to improve adherence and retention, this model could be expanded to other family medicine clinics, potentially reducing the reliance on psychiatric specialists and increasing access to MOUD in underserved areas.

With the recent removal of the DEA-X waiver requirement, family medicine physicians are now able to prescribe buprenorphine/naloxone without additional regulatory barriers. This change represents a crucial step in expanding access to MOUD, particularly in underserved areas where specialized addiction treatment services are scarce. Family medicine physicians are ideally positioned to manage OUD due to their ongoing relationships with patients and their ability to provide continuous, integrated care. Clinical pharmacists complement this role by providing specialized expertise in medication management. They ensure the safe and effective use of buprenorphine/naloxone by monitoring for drug interactions, managing dosing, and providing patient education. Their involvement is critical in optimizing treatment plans and improving adherence, ultimately leading to better patient outcomes. Studies have shown that when clinical pharmacists are involved in MOUD, there is a significant reduction in relapse rates and an improvement in overall treatment success. This collaboration between physicians and pharmacists is particularly important in family medicine settings, where comprehensive care is essential.

Impact on Patients/Individuals and Populations

The opioid crisis remains a critical public health issue, with over 70,000 opioid-related overdose deaths reported in 2022 alone. Millions of Americans are affected by OUD, with significant morbidity and mortality associated with the disorder. These alarming statistics underscore the urgent need for effective and accessible treatment options.

The integration of MOUD into family medicine practices, supported by clinical pharmacists, is not just a matter of expanding access but also of enhancing the quality of care for patients with OUD. By empowering family medicine physicians and clinical pharmacists to collaborate in prescribing and managing buprenorphine/naloxone, we can address the opioid crisis more effectively, providing patients with the comprehensive, compassionate care they need to recover and thrive. This approach also helps reduce health disparities, ensuring that all patients, regardless of location or socioeconomic status, have access to life-saving treatments.

How does this project reduce or eliminate health disparities

The diverse array of patients will allow care to be provided to patients of differing gender, race, religion, citizenship status, income level, and health literacy.

Plans for dissemination of findings

Findings presented at two pharmacy conferences including ASHP Midyear Clinical Meeting (December 2024) and Great Lakes Pharmacy Residents Conference (April 2025). Completed findings submitted for publication to a journal.

Plans for implementation of findings

This retrospective review will allow us to observe any trends that lead to therapy discontinuation, maintenance of medication or relapse.

Description of how this project is patient-centered

This project focuses on enhancing care for individuals with opioid use disorder (OUD) by integrating family medicine physicians and clinical pharmacists in a multidisciplinary approach. By utilizing the accessibility of family medicine clinics, especially in underserved areas, it ensures patients receive continuous, holistic care that considers both physical and mental health. The inclusion of clinical pharmacists allows for personalized medication management, improving treatment safety, adherence, and overall patient satisfaction. The project also seeks to build strong, trusting relationships between patients and their care teams, which is crucial for supporting recovery and reducing the stigma associated with addiction. By addressing health disparities, the project ensures that all patients, regardless of background, receive high-quality, compassionate care tailored to their unique needs.

Project Limitations

Small Sample Size

• The small sample size is a result of scheduling limitations. We currently only see patients for MOUD inductions on Monday or Tuesdays. Maintenance appointments can be scheduled any day, Monday-Friday. These patient encounters can be time consuming, usually lasting 40-60 minutes which also places some restrictions. As a result of these considerations, the residency clinic has seen less than 30 of these patients.
• Due to the nature of the residency clinic, there is a lack of continuity with patient visits among the physicians. The clinical pharmacist is engaged with every patient regardless of the physician seeing the patient.

Vulnerable population: Yes

Results

Out of 30 patients screened, 14 met the inclusion and exclusion criteria and were enrolled in the study. Among these, 50% were male, with an average age of 43 years. The majority (71%) identified as white (Table 1). Regarding psychiatric comorbidities, 85.7% of patients had a diagnosed condition for which some were receiving concurrent treatment (Figure 1).

Table 1: Demographic characteristics of patients enrolled in the MOUD program; n=14

	Race
Sex	Black or African American (14%; 2 patients)	Other Race (14%; 2 patients)	White (72%; 10 patients)
Female (50%; 7 patients)	46	39	33.8
Male (50%; 7 patients)	48	41	52.2
	Average of Age in Years using Mean ± SD (Total average = 43.3 years)

Figure 1: Psychiatric Comorbidities; n=14

The average initial Subjective Opiate Withdrawal Scale (SOWS) score was 20 (Figure 2). However, 8% of patients were not experiencing withdrawal symptoms and had negative urine drug screens (UDS) for opioids, though they still reported cravings. (Figure 3). Approximately 38% of patients reported using a single opioid type, while 54% reported using two or more. Figure 4 illustrates the types of opioids reported, based on initial UDS results and/or patient self-reporting. Notably, patients with methamphetamine detected in their UDS were excluded; however, patients with a self-reported history of methamphetamine use (but a negative UDS) were included.

Figure 2: SOWS Scores; n=14

Figure 3: Number of Prior Opioids Use; n=14

Figure 4: Types of Opioids Reported or Detected (Including Methamphetamine Exclusions); n=14

In terms of Medications for Opioid Use Disorder (MOUD) induction, 78.6% of patients were induced in the family medicine clinic (Figure 5). The remaining patients were induced at external sites and referred to the residency clinic for continued care. For all 14 patients, a clinical pharmacist was involved in each visit—providing services such as counseling, medication dosing, monitoring for side effects and adverse reactions, and conducting UDS, in collaboration with family medicine residents (Figure 6).

Figure 5: Induction Site; n=14

Figure 6: Pharmacist Involved; n=14

Recognizing the essential role of behavioral health in treating opioid use disorder (OUD), all patients were encouraged to engage in behavioral health services (e.g., Narcotics Anonymous). However, only 50% of patients accepted and utilized these services (Figure 7). Figure 8 depicts appointment progression. While care plans were individualized, it was noted that 42% of patients extended their follow-up visits beyond the weekly interval, with follow-up intervals of 30 days or more. Half of the patients required the maximum allowable daily dose of buprenorphine/naloxone (16 mg/4 mg) for symptom control (Figure 9).

Figure 7: Behavioral Health Services Used; n=14

Figure 8: Appointment Progression; n=14

Figure 9: Buprenorphine/Naloxone Total Daily Dose; n=14

Regarding program retention, 35.7% (5 of 14 patients) remained engaged in care. This includes 14.3% (2 patients) who achieved complete remission and 21.4% (3 patients) who remained enrolled for at least three months. Three patients (21.4%) were lost to follow-up, and 42.9% (6 patients) were referred to external programs (Figure 10). Reasons for referral included positive UDS, violation of treatment agreements, preference for long-acting injectable formulations, or a need for higher acuity psychiatric care. The residency clinic implemented a referral system that ensures patients are seen by psychiatric providers within 7 days.

Figure 10: Program Retention Rate; n=14

UDS results showed that 78% (11 patients) had consistently negative results—positive only for buprenorphine/naloxone with no detection of opioids or illicit substances. Two patients (14%) had positive UDS for other substances and were referred for higher-level care. One patient did not have a UDS performed due to their initial visit being virtual—an identified gap in protocol (Figure 11).

Figure 11: Urine Drug Screen Results; n=14

Figure 12 displays the average number of MOUD visits per patient subgroup. Patients who achieved remission did so within an average of 6 visits. Regarding weaning from buprenorphine/naloxone, 43% of patients self-titrated off the medication. The remaining patients either had not initiated a taper or had attempted to taper but resumed MOUD during the study period (Figure 13).

Figure 12: Average Number of MOUD^* Visits; n=14

Figure 13: Wean Off Method; n=14

In summary, of the 14 patients included in this study:

• Two patients (14.3%) achieved full remission with consistent negative UDS and an average of 6 visits.
• Three patients (21.4%) were actively enrolled for at least three months with consistent UDS.
• The overall program retention rate was 35.7%.
• The consistency rate for negative UDS was 85%.

Statistical Analysis

Statistical analysis was performed using single-sample t-tests to compare urine drug screen (UDS) consistency and program retention rates between our study group and a previously published comparative group.

In our study, 12 of 14 patients (86%) demonstrated consistent negative UDS results, compared to 58 of 61 patients (95.1%) in the comparative group; this difference did not differ significantly (p = 0.205). Suggesting that our findings are consistent with the comparative study in terms of patient adherence to the treatment regimen and maintaining negative urine drug screens.

Regarding program retention rates, only 5 out of 14 patients (35.7%) in our study were retained, which significantly differs from the comparative group’s retention rate of 88.7% (63 out of 71 patients) (p < 0.0001), indicating that our study does not align with the comparative study in terms of retention outcomes.

Discussion

This retrospective analysis evaluated the impact of a multidisciplinary approach involving family medicine physicians and clinical pharmacists on patient outcomes in a residency-based Medications for Opioid Use Disorder (MOUD) program for opioid use disorder (OUD). National trends and previous studies have demonstrated the efficacy of collaborative care models—particularly those integrating pharmacists—in improving patient outcomes in MOUD settings.¹²^,¹³

In our study, clinical pharmacists were involved in every patient encounter, contributing to high rates of medication adherence and low relapse rates, as evidenced by the 85.7% consistency in negative urine drug screens (UDS). This finding aligns with the collaborative care study by Wu et al., which showed a 95.1% UDS consistency rate among patients managed by physician-pharmacist teams.¹³ Although our consistency rate was slightly lower, the difference was not statistically significant (p = 0.205), suggesting comparable success in sustaining opioid abstinence within a primary care setting.

Conversely, our program retention rate of 35.7% was significantly lower than the 88.7% reported in the Wu et al. trial (p < 0.0001).¹³ Several factors likely contributed to this disparity. Our small sample size (n = 14) limits generalizability and may amplify statistical variability. Additionally, logistical and structural constraints—such as the lack of continuity with rotating resident physicians—may have hindered long-term patient engagement. In contrast, attending physicians and clinical pharmacists provided consistent oversight throughout, underscoring the importance of provider continuity in chronic care management.¹²

Another important factor influencing outcomes is the complexity of the patient population. Although patients with confirmed polysubstance use were excluded, more than half of the enrolled patients reported using multiple opioids, and 85.7% had documented psychiatric comorbidities. These factors are known to complicate adherence and frequently require more intensive behavioral health support.³^,⁶ While all patients were encouraged to participate in behavioral health services, only 50% engaged in behavioral health services, highlighting a persistent gap in integrated care. This aligns with the literature on underutilization of mental health services in MOUD programs, especially within primary care.⁸^,⁹ However, prior studies have shown that buprenorphine alone, even without psychosocial services, can yield significant improvements in retention and abstinence. ¹⁴

In addition, the retrospective reliance on patient self-reporting may have led to misclassification of opioid types, particularly given counterfeit oxycodone pills containing fentanyl and the colloquial use of ‘heroin’ to describe powder fentanyl. While this does not alter primary outcomes, it limits precision in opioid-type analysis.

Furthermore, qualitative data such as patient perspectives, barriers to retention, and reasons for disengagement were not collected. Future research should incorporate qualitative interviews alongside quantitative outcomes to provide deeper insight into patient experience and program effectiveness. Although this physician–pharmacist MOUD model was implemented in a rural residency clinic, similar approaches could benefit urban populations. In dense city environments, integrated models could reduce stigma by embedding MOUD within primary care, expand access in high-volume clinics, and provide robust medication oversight. However, urban implementation faces challenges, including greater patient volumes, social complexity (e.g., housing instability, mental illness), and the need for rapid referral pathways. Future studies should explore adaptations of this model in urban environments to evaluate scalability and equity.

To support patient safety and optimize care, residents were instructed to refer patients to addiction specialists when cases became too complex—such as repeated missed appointments, inconsistent UDS results, or signs of polysubstance use. The residency clinic has a standing agreement with local addiction providers to ensure these patients are seen within seven days, facilitating timely transitions to higher-acuity care.

Despite lower retention compared to controlled clinical trials, our program's 35.7% retention rate falls within the broader national average for buprenorphine MOUD programs. Studies have reported considerable variability in 6-month retention rates, ranging from 19.1% to 64.0%, depending on study design, population, and care setting.^13,15 This variability is often attributed to high heterogeneity in inclusion/exclusion criteria, definitions of retention, treatment duration, and program structure—making direct comparison difficult but placing our results in reasonable context.

Notably, a subset of patients achieved meaningful outcomes: 14.3% reached complete remission within an average of six visits, and 21.4% remained in care for at least three months with consistent follow-up and stable progress. These findings suggest that individualized care plans, early engagement, and consistent provider involvement may play a key role in improving long-term recovery outcomes. This is consistent with prior literature supporting integrated, patient-centered MOUD delivery models in family medicine settings.⁴^,⁷

Finally, operational gaps were identified, such as inconsistent UDS testing during virtual inductions. Addressing these procedural inconsistencies—alongside improved behavioral health integration and continuity planning—may enhance retention and clinical outcomes in future iterations of the program.

Conclusion

This study reinforces the feasibility of a multidisciplinary MOUD model in a family medicine residency clinic, particularly with regard to medication adherence and early treatment success. The universal involvement of clinical pharmacists was associated with high rates of negative UDS and safe medication management, consistent with published outcomes.¹²^,¹³ However, the lower-than-expected program retention rate highlights the need for improved logistical structures, continuity of care, and more robust behavioral health support within primary care-based MOUD programs.

Despite limitations—including a small sample size—this study offers valuable insight into the real-world implementation of MOUD in medically underserved settings. With the removal of the DEA-X waiver and growing support for integrated care, family medicine clinics are increasingly well-positioned to expand access to life-saving MOUD services.⁵ Future research with larger patient populations, extended follow-up periods, and standardized care protocols will be essential in validating and optimizing this care model for broader implementation.

List of Abbreviations

AAFP: American Academy of Family Physicians

AHRQ: Agency for Healthcare Research and Quality

ASHP: American Society of Health-System Pharmacists

BP: Blood Pressure

CDC: Centers for Disease Control and Prevention

COWS: Clinical Opiate Withdrawal Scale

DEA: United States Drug Enforcement Administration

DEA-X waiver: DATA 2000 “X waiver” permitting buprenorphine prescribing

DSM-5: Diagnostic and Statistical Manual of Mental Disorders, 5th Ed.

eCW: eClinicalWorks (electronic health record system)

FDA: Food and Drug Administration

FWMEP: Fort Wayne Medical Education Program

GAD-7: Generalized Anxiety Disorder 7 questionnaire

HR: Heart Rate

IRB: Institutional Review Board

MAT: Medication Assisted Treatment

MOUD: Medications for Opioid Use Disorder

OUD: Opioid Use Disorder

OTP: Opioid Treatment Program

PHQ-9: Patient Health Questionnaire 9

RR: Respiratory Rate

ROS: Review of Systems

SAMHSA: Substance Abuse and Mental Health Services Administration

SOWS: Subjective Opiate Withdrawal Scale

UDS: Urine Drug Screen

Conflict of Interest

The authors declare that they have no relevant financial or personal relationships with any commercial entities that could be perceived as having a direct or indirect interest in the subject matter of this research.

Author Contributions

Conceptualization, Aubrey Baccari; Methodology, Sally Mukatash Pauls, Aubrey Baccari, and Brian Henriksen; Data Curation, Sally Mukatash Pauls; Formal Analysis, Brian Henriksen; Investigation, Sally Mukatash Pauls; Visualization, Sally Mukatash Pauls; Writing – Original Draft, Sally Mukatash Pauls; Writing – Review & Editing, Aubrey Baccari and Brian Henriksen; Supervision, Aubrey Baccari and Brian Henriksen; Project Administration, Sally Mukatash Pauls.

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