Counselor training and attitudes toward pharmacotherapies for opioid use disorder

ABSTRACT

Background: Methadone and buprenorphine have been demonstrated to be effective in the treatment of opioid use disorder (OUD), especially when combined with psychosocial treatment. Despite buprenorphine's association with fewer withdrawal symptoms and lessened risk of abuse, compared with methadone, its adoption remains limited. Given the vital role that counselors may play in its successful implementation, their knowledge and perceptions of opioid agonist therapy may be facilitators or barriers to its acceptance. Methods: Informed by diffusion theory, the current study examined perceptions of buprenorphine's and methadone's acceptability among 725 counselors employed in a nationally representative sample of substance use disorder treatment centers. First, we provided descriptive statistics about medication diffusion, extent of training received about the medications, and perceptions of acceptability of each medication. Then, we compared acceptability of opioid agonists with other treatment approaches for OUD. Finally, we conducted 2 ordinary least squares regressions to examine counselor acceptability of buprenorphine and of methadone. Results: Descriptive statistics suggested that diffusion of information about buprenorphine and methadone was not complete, and training was not extensive for either medication. Counselors reported greater acceptability and training of buprenorphine compared with methadone. Methadone was rated as the least acceptable among all other treatment approaches. Multivariate analyses indicated regional differences, and that medication-specific training, adaptability, and educational attainment were positively related with perceptions of acceptability of either medication, even after controlling for organizational characteristics. Adherence to a 12-step orientation was negatively associated with acceptability. Conclusions: Dissemination of information about opioid agonist therapy is occurring. Nevertheless, the fact that 20% of counselors admitted not knowing enough about either buprenorphine's or methadone's effectiveness is surprising in light of the extensive literature documenting their effectiveness. Future research should focus upon different types of training that can inform physicians, counselors, and patients about the use of opioid agonist therapy.

KEYWORDS:

• Buprenorphine
• counselor attitudes
• medication-assisted treatment
• methadone
• opioid agonist therapy
• opioid use disorder
• substance abuse

Author contributions

All authors made substantial contributions to this paper. Lydia Aletraris contributed to research conception and design, collection of data, analysis and interpretation of results, writing, and revision. Mary Bond Edmond contributed to research conception and design, analysis and interpretation of results, writing, and revision. Maria Paino contributed to research conception and design, analysis and interpretation of results, writing, and revision. Dail Fields contributed to research conception and design, collection of data, and revision. Paul Roman contributed to research conception and design, collection of data, and revision.

Funding

This research was supported by the National Institute on Alcohol Abuse and Alcoholism (grant R01AA015974). NIAAA had no further role in study design, data collection, analysis, and interpretation of data, or in the writing of this article. The content is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health or the NIAAA. The authors declare that they have no conflicts of interest.