Training is a common component of initiatives that advocate greater involvement of generalist physicians (GPs) in treating opiate use disorders. British researchers measured the effectiveness of training GPs to change knowledge, attitudes, and clinical practices around opiate use disorders.

Sixty-three GPs were randomized to a 6-month training certificate course, while 49 were randomized to a waiting list control (20 of whom bypassed the waiting list and completed the course by paying for it themselves). All GPs were interviewed at study enrollment and 6 months later. Analysis of responses showed that

• GPs who underwent training showed a marked improvement in knowledge;
• the proportion who were "very confident" in prescribing methadone for maintenance increased significantly in both groups but more so in the intervention group (33% to 72% versus 31% to 55% in the control group);
• the proportion of participants who saw patients who misused opiates (about 90% in both groups at enrollment) and prescribed methadone to these patients did not significantly change in either group. However, an increase in methadone prescribing did occur in the intervention group while it decreased in the control group.

Comments by James Harrison, MHS, CADC:
This study makes a clear case for training generalist physicians in opiate use disorders. Many physicians working with opiate users have acknowledged their frustrations around a lack of opiate misuse knowledge and clinical skills. Improved physician confidence could result in better outcomes for patients presenting in emergency rooms, family practices, and outpatient treatment settings.

Comments by Peter D. Friedmann, MD, MPH, Associate Editor of Alcohol, Other Drugs, and Health: Current Evidence:
Even though the level of interest in treating drug use was high and subject to ceiling effects and the control group was contaminated with GPs who paid for their own training, this rigorous study still found positive effects of training on physicians' confidence. Abundant theoretical and empirical work suggests that such confidence is key to physician involvement in the care of substance use disorders. These findings are reassuring in light of the ongoing training initiative to promote the dissemination of office-based buprenorphine maintenance in the United States.