Medication Approaches for Patients With Opioid Use Disorders: Differences Between Primary Care Clinics and Specialty Addiction Treatment ProgramsMedication Approaches for Patients With Opioid Use Disorders: Differences Between Primary Care Clinics and Specialty Addiction Treatment Programs
Addiction Medicine: Beyond the Abstract
Shawn McNeil, MD talks with Drs Mark McGovern and Berkeley Franz about why access to medications for opioid use disorder differs between primary care and specialty addiction programmes. They discuss barriers, community factors, and practical strategies for making evidence-based treatment more widely available.
29:14•17 Sept 2026
Medication for Opioid Use Disorder: Why Access Still Depends on Where You Go
Episode Overview
- Primary care clinicians often lack addiction training, confidence, and fear stigma, which limits their willingness to prescribe medications for opioid use disorder.
- Specialty addiction treatment programmes face different barriers, including abstinence-focused cultures, medication stigma, and limited budgets or prescribers.
- Many addiction programmes are located in communities with high overdose rates and few medication providers, making them priority sites for implementation support.
- Tailored strategies that address local attitudes, resources, and workflow are more effective than relying on training, education, or funding alone.
- Peer mentorship between primary care providers and exposure to real recovery stories can help reduce stigma and increase MOUD adoption.
“"Training alone will not work. Education alone will not work. Actually, money alone will not work."”
What drives someone to seek a life without opioid dependence, and how can healthcare systems actually support that change? This conversation zeroes in on medications for opioid use disorder (MOUD) and why access to them still varies so wildly between primary care clinics and specialty addiction treatment programmes. You’ll hear Journal Podcast Editor Shawn McNeil, MD talking with Dr. Mark McGovern and Dr. Berkeley Franz about their cross-sectional study on MOUD use in different clinical settings.
Franz shares how moving to rural Appalachia and losing family members to opioid overdose pushed her towards research on buprenorphine and harm reduction, while McGovern describes turning his own experience of addiction in the family into a lifelong career focused on implementation science. The episode breaks down the very real barriers to MOUD in primary care: limited addiction training, low confidence, worries that “the floodgates are going to open”, and even fear of being labelled an “addiction doctor”.
On the specialty addiction side, the hurdles look different—staff beliefs about abstinence-only recovery, stigma towards medications, thin budgets, and programmes without any prescribers on staff. Franz and McGovern talk through how community factors matter too, with many specialty programmes sitting in areas with high overdose rates, lots of opioid prescribing, and very few medication providers. They argue these clinics may be the most critical places to support because they sit in treatment deserts.
You’ll also hear practical ideas: peer mentorship for primary care clinicians, creative use of telehealth, tailored implementation strategies instead of one-size-fits-all training, and the power of simply witnessing patients quickly stabilise, regain custody of children, and rebuild their lives with MOUD. If you’re curious about how medicine, policy, stigma, and real-world practice intersect around opioid treatment, this episode offers a grounded look at what still blocks progress—and where change is already starting.
Could these approaches shift how your own clinic or service thinks about medications for opioid use disorder?
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