Policies regarding use of medications for opioid use disorder in professional recovery programs: A scoping review

Abstract

Background: In the U.S., medications for opioid use disorder (MOUD) include methadone, buprenorphine, and naltrexone. Despite substantial evidence of efficacy, the use of MOUD by health professionals remains controversial. This scoping review sought to identify and describe policies related to the use of MOUD by physicians, pharmacists, and nurses in professional health programs (PHP). Methods: A systematic search of PubMed, Medline, Web of Science, and Google Scholar was performed in August 2020 to identify pertinent articles from the U.S. which were then evaluated for inclusion by a team of trained reviewers. Results: Nine articles were ultimately identified for inclusion, and their years of publication ranged from 1984 to 2012. The treatment of physicians was addressed in seven articles, nurses in four, and pharmacists in two. Data from one veterinarian and several dentists could not be disaggregated from three studies. Naltrexone was the most commonly accepted form of MOUD within PHPs. A 2011 survey of physician and nurse PHP administrators found that 11/22 (50%) physician programs and 15/33 (45%) nursing programs forbade practice reentry while taking buprenorphine with the remainder indicating it could be allowed under some circumstances. The use of methadone within PHPs was extremely rare, and no specific details regarding PHP policies related to its use or practice reentry could be identified. No articles reported specifically on practice reentry policies for pharmacists. Conclusions: This scoping review identified one article detailing explicit policies concerning MOUD use in the target professions. Implicit policies extrapolated from other articles found that naltrexone was the most commonly accepted form of MOUD, with methadone and buprenorphine being avoided due to dubious concerns of impairment. A unified, contemporary, comprehensive survey of current PHP policies and evaluation of actual treatment data to ascertain real-world practices is needed.

Keywords:

• Physicians
• pharmacists
• nurses
• opioid-related disorders
• opiate substitution treatment
• professional impairment

Acknowledgments

The authors thank Roxanne Bogucka, STEM Liaison Librarian at The University of Texas at Austin, for consultation regarding search strategies and scoping review resources.

Disclosure statement

Dr. Hill reports serving on the Hikma Specialty Inc. Community Advisory Board in December 2020. No other authors have any potential conflicts of interest to report.

Author contributions

L.H. conceived of the review. K.W. engineered search criteria for databases and compiled articles into Rayyan. S.T., J.P., C.Z., and L.L. participated in the review. K.W. served as a third reviewer in the case of disagreement, and L.H. provided a final layer of review. K.W. and L.H. drafted the manuscript, and all authors (K.W., L.H., J.P., S.T., C.Z., and L.L.) provided critical feedback and contributed to the writing of the manuscript.

Registration

Open Science Foundation, DOI: 10.17605/OSF.IO/RBVYW.