A scoping review of opioid agonist treatment in Australian general practice

In Australia, opioid use disorder is a major public health concern, and opioid agonist treatment (OAT) is an effective and evidence-based approach for treating opioid use disorder, reducing morbidity, mortality and societal cost. In Australia, 60% of OAT prescribing occurs in general practice, but significant barriers exist. This scoping review aimed to find research describing the characteristics and evaluation of different models of primary care-based OAT in Australia. Following the PRISMA guidelines for scoping reviews, a systematic search was conducted of PubMed, Embase, Scopus and CINAHL, and several grey literature databases. We conducted a narrative synthesis, and derived study themes inductively from included studies. We identified 24 relevant articles over 34 years that reported primary research on general practice-based OAT. Seven studies evaluated general practice OAT; eight examined prescriber attitudes, behaviour and workforce; two described single-models of care; four investigated primary care OAT policy; and two studies examined consumer experiences. The studies showed primary care OAT was as effective as specialist care for retention in OAT; however, prescriber deficits exist, with lack of remuneration and stigma identified as common barriers. The multidisciplinary models of care all received external funding, with GPs well placed, but underfunded, to coordinate care. The limited research demonstrates research gaps in service delivery, models of care, funding and views of people who use drugs. Future research scope needs to be broadened to encompass improved national monitoring datasets, patient views, models of care, holistic support and coordination, and structural supports to recruit and retain active prescribers.